WorldWideScience

Sample records for asthma management opportunities

  1. Internet-based self-management offers an opportunity to achieve better asthma control in adolescent

    NARCIS (Netherlands)

    Meer, V. van der; Stel, H.F. van; Detmar, S.B.; Otten, W.; Sterk, P.J.; Sont, J.K.

    2007-01-01

    Background: Internet and short message service are emerging tools for chronic disease management in adolescents, but few data exist on the barriers to and benefits of internet-based asthma self-management. Our objective was to reveal the barriers and benefits perceived by adolescents with well-contr

  2. Managing Allergies, Asthma 101

    Science.gov (United States)

    ... medlineplus.gov/news/fullstory_158635.html Managing Allergies, Asthma 101 Doctor offers advice to students who will ... 3, 2016 (HealthDay News) -- Teens with allergies or asthma who are heading for college later this year ...

  3. Defining and managing risk in asthma.

    Science.gov (United States)

    Blakey, J D; Zaidi, S; Shaw, D E

    2014-08-01

    Asthma attacks are a major global source of morbidity and cost. The incidence and impact of asthma attacks have not improved despite widespread adoption of effective universal treatment guidelines. Consequently, there is increasing interest in managing asthma based on specific assessments of both current symptoms and future risk. In this review, we consider 'risk' in asthma, and how it might be assessed from the patient's history and objective measurements. We also discuss the potential for encouraging shared decision-making and improving medical consensus through explicit communication of risk and highlight the potential opportunities and challenges in risk assessment to improve asthma management through individualised treatment strategies. PMID:24773229

  4. Asthma patient education opportunities in predominantly minority urban communities.

    Science.gov (United States)

    Zayas, Luis E; McLean, Don

    2007-12-01

    Disenfranchised ethnic minority communities in the urban United States experience a high burden of asthma. Conventional office-based patient education often is insufficient to promote proper asthma management and coping practices responsive to minority patients' environments. This paper explores existing and alternative asthma information and education sources in three urban minority communities in western New York State to help design other practical educational interventions. Four focus groups (n = 59) and four town hall meetings (n = 109) were conducted in one Hispanic and two black communities. Focus groups included adult asthmatics or caretakers of asthmatics, and town meetings were open to all residents. A critical theory perspective informed the study. Asthma information and education sources, perceptions of asthma and ways of coping were elicited through semi-structured interviews. Data analysis followed a theory-driven immersion-crystallization approach. Several asthma education and information resources from the health care system, media, public institutions and communities were identified. Intervention recommendations highlighted asthma workshops that recognize participants as teachers and learners, offer social support, promote advocacy, are culturally appropriate and community-based and include health care professionals. Community-based, group health education couched on people's experiences and societal conditions offers unique opportunities for patient asthma care empowerment in minority urban communities. PMID:16896054

  5. Asthma as a Comorbidity in Hospitalized Patients: A Potential Missed Opportunity to Intervene.

    Science.gov (United States)

    Self, Timothy H; Owens, Ryan E; Mancell, Jimmie; Nahata, Milap C

    2016-06-01

    Asthma is a frequent comorbidity in hospitalized children and adults. Patients with a history of asthma may have no breathing complaints or abnormal chest exam findings to trigger care for this comorbidity during hospitalization. Consequently, this may lead to a potential missed opportunity to discuss asthma as a comorbidity and ongoing issue to ensure its optimal management at home. Our goal is to raise awareness that such patient encounters may represent opportunities for health care professionals to optimize asthma management. Despite focusing on the present illness and limited time availability, asthma care may be improved in a time-efficient manner in these patients.

  6. The management of acute asthma.

    Science.gov (United States)

    Cross, S

    1997-04-01

    Health professionals likely to come into contact with people experiencing an acute episode of asthma, such as school nurses, ambulance personnel and A&E staff, need clear guidelines on management. The British Thoracic Society guidelines, revised this year, advise on the categorisation of asthma, assessment and treatment.

  7. Clinical asthma phenotypes in the real world: opportunities and challenges

    OpenAIRE

    Clementine Bostantzoglou; Vicky Delimpoura; Konstantinos Samitas; Eleftherios Zervas; Frank Kanniess; Mina Gaga

    2015-01-01

    Key Points Asthma is a heterogeneous syndrome ranging from mild disease with barely noticeable symptoms to very severe disease with constant symptoms that may greatly hinder patients’ quality of life.; The aim of asthma treatment is control of asthma and the prevention of risk of exacerbations and fixed airflow limitation.; Asthma management must be individualised; tailored not only to the severity of the disease but importantly, to the phenotypic characteristics of the patient and m...

  8. Childhood Asthma Management Pre- and Post-Incident Asthma Hospitalization

    OpenAIRE

    Bianchi, Marina; Clavenna, Antonio; Sequi, Marco; Bortolotti, Angela; Fortino, Ida; Merlino, Luca; Bonati, Maurizio

    2013-01-01

    Many hospitalizations for asthma could potentially be avoided with appropriate management. The aim of this study was to analyze data on disease management of a paediatric population with a hospitalization for asthma. The study population comprised 6–17 year old subjects belonging to three local health units of the Lombardy Region, northern Italy. Regional administrative databases were used to collect data on: the number of children with an incident hospitalization for asthma during the 2004–2...

  9. Supported self-management for asthma

    OpenAIRE

    Hilary Pinnock

    2015-01-01

    Key points Self-management education in asthma is not an optional extra. Healthcare professionals have a responsibility to ensure that everyone with asthma has personalised advice to enable them to optimise how they self-manage their condition.; Overviews of the extensive evidence-base conclude that asthma self-management supported by regular professional review, improves asthma control, reduces exacerbations and admissions, and improves quality of life.; Self-management education sh...

  10. Managing Asthma at School.

    Science.gov (United States)

    Madden, Julie A.

    2000-01-01

    School personnel must know which students have asthma, typical warning signs, and appropriate actions in an emergency. Administering appropriate medication and reducing environmental triggers are not enough. Policymaking in schools and workplaces and legislation to increase health care access and eliminate substandard housing and air pollution are…

  11. Psychosocial Components of Asthma Management in Children

    OpenAIRE

    Wade, Shari L.

    2000-01-01

    Asthma is a growing health problem that affects 4.8 million children in the US alone. This paper considers empirical studies from the past 20 years examining the relationship between psychosocial factors and asthma management and morbidity. Research indicates that psychosocial factors, including risk and protective factors in the social environment, and knowledge, attitudes and skills pertaining to asthma management, can play an important role in asthma management, adherence and morbidity. Ca...

  12. The disease management approach to controlling asthma.

    Science.gov (United States)

    Haahtela, T

    2002-02-01

    Asthma has become an important public health issue worldwide and certain groups, such as children, are at particular risk of the disease. Often asthma remains under-diagnosed and under-treated. Despite these worrying trends, the disease management approach to asthma control can help most asthma patients achieve a 'normal' way of life. The increased prevalence and greater diagnostic awareness of asthma have placed increased demands on healthcare resources, but effective asthma control can minimize the personal, social and economic burdens of asthma. Early diagnosis and immediate anti-inflammatory treatment is the first step in gaining control of symptoms. A stepwise approach is then used to classify asthma severity and treatment, with the number and frequency of medications increasing (step up) as asthma severity increases and decreasing (step down) when asthma is under control. This stepwise approach to asthma management necessitates regular review of treatment once asthma is under control. However, effective asthma management is dependent on successful patient education, adherence to prescribed medication and good doctor patient partnerships. Current treatment guidelines recommend the use of a written asthma management plan that should be agreed between the doctor and patient. These plans should cover all aspects of asthma treatment, including prevention steps for long-term control and action steps to stop attacks once a worsening in asthma has been recognized. This comprehensive approach to asthma management increases the likelihood of achieving asthma control, which in turn reduces the need for emergency visits to the hospital or clinic and reduces the limitations on physical activity previously imposed by the condition.

  13. Childhood Asthma Management and Environmental Triggers.

    Science.gov (United States)

    Hollenbach, Jessica P; Cloutier, Michelle M

    2015-10-01

    Asthma is the most common chronic disease among children. It cannot be prevented but can be controlled. Industrialized countries experience high lifetime asthma prevalence that has increased over recent decades. Asthma has a complex interplay of genetic and environmental triggers. Studies have revealed complex interactions of lung structure and function genes with environmental exposures such as environmental tobacco smoke and vitamin D. Home environmental strategies can reduce asthma morbidity in children but should be tailored to specific allergens. Coupled with education and severity-specific asthma therapy, tailored interventions may be the most effective strategy to manage childhood asthma.

  14. Childhood asthma management pre- and post-incident asthma hospitalization.

    Directory of Open Access Journals (Sweden)

    Marina Bianchi

    Full Text Available Many hospitalizations for asthma could potentially be avoided with appropriate management. The aim of this study was to analyze data on disease management of a paediatric population with a hospitalization for asthma. The study population comprised 6-17 year old subjects belonging to three local health units of the Lombardy Region, northern Italy. Regional administrative databases were used to collect data on: the number of children with an incident hospitalization for asthma during the 2004-2006 period, anti-asthma therapy, specialist visit referrals, and claims for spirometry, released in the 12 months before and after hospitalization. Each patient's asthma management profile was compared with GINA guideline recommendations. Among the 183 hospitalized subjects, 101 (55% received therapy before hospitalization and 82 (45% did not. 10% did not receive any therapy either before or after hospital admission and in 13% the therapy was discontinued afterward. Based on GINA guidelines, asthma management adhered to recommendations only for 55% of subjects. Results may suggest that for half of hospitalized subjects, inaccurate diagnosis, under-treatment/scarce compliance with asthma guidelines by physicians, and/or scarce compliance to therapy by patients/their parents occurred. In all these cases, hospitalization would be a proxy indicator of preventable poor control of disease, rather than a proxy indicator of severity.

  15. Asthma

    Directory of Open Access Journals (Sweden)

    Kim Harold

    2011-11-01

    Full Text Available Abstract Asthma is the most common respiratory disorder in Canada. Despite significant improvement in the diagnosis and management of this disorder, the majority of Canadians with asthma remain poorly controlled. In most patients, however, control can be achieved through the use of avoidance measures and appropriate pharmacological interventions. Inhaled corticosteroids (ICSs represent the standard of care for the majority of patients. Combination ICS/long-acting beta2-agonists (LABA inhalers are preferred for most adults who fail to achieve control with ICS therapy. Allergen-specific immunotherapy represents a potentially disease-modifying therapy for many patients with asthma, but should only be prescribed by physicians with appropriate training in allergy. Regular monitoring of asthma control, adherence to therapy and inhaler technique are also essential components of asthma management. This article provides a review of current literature and guidelines for the appropriate diagnosis and management of asthma.

  16. Barriers to Asthma Management for School Nurses: An Integrative Review

    Science.gov (United States)

    Hanley Nadeau, Ellen; Toronto, Coleen E.

    2016-01-01

    Childhood asthma is a growing health concern. Asthma is the most common chronic illness of childhood and a leading cause of emergency room visits, hospitalizations, and school absenteeism. School nurses play a valuable role in asthma management. The purpose of this integrative review is to examine barriers to asthma management for school nurses in…

  17. Perceived Triggers of Asthma: Key to Symptom Perception and Management

    OpenAIRE

    Janssens, Thomas; Ritz, Thomas

    2013-01-01

    Adequate asthma management depends on an accurate identification of asthma triggers. A review of the literature on trigger perception in asthma shows that individuals vary in their perception of asthma triggers and that the correlation between self-reported asthma triggers and allergy tests is only modest. In this paper, we provide an overview of psychological mechanisms involved in the process of asthma triggers identification. We identify sources of errors in trigger identification and targ...

  18. Supported self-management for asthma

    Directory of Open Access Journals (Sweden)

    Hilary Pinnock

    2015-06-01

    The evidence in favour of supported self-management for asthma is overwhelming. Self-management including provision of a written asthma action plan and supported by regular medical review, almost halves the risk of hospitalisation, significantly reduces emergency department attendances and unscheduled consultations, and improves markers of asthma control and quality of life. Demographic and cultural tailoring enables effective programmes to be implemented in deprived and/or ethnic communities or within schools. A crucial component of effective asthma self-management interventions is the provision of an agreed, written personalised action plan which advises on using regular medication, recognising deterioration and appropriate action to take. Monitoring can be based on symptoms or on peak flows and should specify thresholds for action including increasing inhaled steroids, commencing oral steroids, and when (and how to seek professional help. Plans should be personalised to reflect asthma severity and treatment regimes, avoidance of triggers, co-morbid rhinitis and the individual’s preferences. Implementation is a challenge. Systematic review evidence suggests that it is possible to implement asthma self-management in routine care, but that to be effective this requires a whole systems approach which considers implementation from the perspective of patient education and resources, professional skills and motivation and organisation priorities and routines.

  19. Perceived triggers of asthma: key to symptom perception and management.

    Science.gov (United States)

    Janssens, T; Ritz, T

    2013-09-01

    Adequate asthma management depends on an accurate identification of asthma triggers. A review of the literature on trigger perception in asthma shows that individuals vary in their perception of asthma triggers and that the correlation between self-reported asthma triggers and allergy tests is only modest. In this article, we provide an overview of psychological mechanisms involved in the process of asthma triggers identification. We identify sources of errors in trigger identification and targets for behavioural interventions that aim to improve the accuracy of asthma trigger identification and thereby enhance asthma control.

  20. Challenges of Asthma Management for School Nurses in Districts with High Asthma Hospitalization Rates

    Science.gov (United States)

    Liberatos, Penny; Leone, Jennifer; Craig, Ann Marie; Frei, Elizabeth Mary; Fuentes, Natalie; Harris, India Marie

    2013-01-01

    Background: School nurses play a central role in assisting elementary school children in managing their asthma, especially those in higher-risk school districts that are at increased risk of uncontrolled asthma. Study purposes are to (1) identify barriers to asthma management by school nurses in higher-risk school districts; and (2) assess the…

  1. Scheduled asthma management in general practice generally improve asthma control in those who attend

    DEFF Research Database (Denmark)

    Backer, Vibeke; Bornemann, Maja; Knudsen, Anja Dorte Brandt;

    2012-01-01

    Successful asthma management involves guideline-based treatment and regular follow-up. We aimed to study the level of disease control in asthmatic individuals managed by their GP and a dedicated nurse when using a systematic asthma consultation guide based on Global Initiative of Asthma guideline...

  2. Internet-based self-management in asthma

    OpenAIRE

    van der Meer, Victor

    2010-01-01

    This thesis describes the role of internet-based support in the delivery of an asthma self management program. First, the compliance and reliability of home lung function monitoring, one of the key features of asthma self-management, was studied and appeared to be high over a 4-week period. Second, we explored intrinsic barriers to current asthma management and revealed possible benefits from internet-based asthma self-management. Participants considered feasible electronic monitoring, easily...

  3. Biomarkers in the Management of Difficult Asthma.

    Science.gov (United States)

    Schleich, Florence; Sophie, Demarche; Renaud, Louis

    2016-01-01

    Difficult asthma is a heterogeneous disease of the airways including various types of bronchial inflammation and various degrees of airway remodeling. Therapeutic response of severe asthmatics can be predicted by the use of biomarkers of Type2-high or Type2-low inflammation. Based on sputum cell analysis, four inflammatory phenotypes have been described. As induced sputum is timeconsuming and expensive technique, surrogate biomarkers are useful in clinical practice. Eosinophilic phenotype is likely to reflect ongoing adaptive immunity in response to allergen. Several biomarkers of eosinophilic asthma are easily available in clinical practice (blood eosinophils, serum IgE, exhaled nitric oxyde, serum periostin). Neutrophilic asthma is thought to reflect innate immune system activation in response to pollutants or infectious agents while paucigranulocytic asthma is thought to be not inflammatory and characterized by smooth muscle dysfunction. We currently lack of user-friendly biomarkers of neutrophilic asthma and airway remodeling. In this review, we summarize the biomarkers available for the management of difficult asthma. PMID:26467509

  4. Asthma Risk Profiles of Children Participating in an Asthma Education and Management Program

    Science.gov (United States)

    Wilson, Candice; Rapp, Kristi Isaac; Jack, Leonard, Jr.; Hayes, Sandra; Post, Robert; Malveaux, Floyd

    2015-01-01

    Background: Focused risk assessment is essential in the effective management of asthma. Purpose: This study identified and examined correlations among areas of pediatric asthma risk and determined associations between these risks and demographic characteristics. Methods: This exploratory study identified risk factors that affect asthma management…

  5. Role of Asthma Education in the Management of Adult Asthma

    Directory of Open Access Journals (Sweden)

    Johanne Côté

    1995-01-01

    Full Text Available When a patient is newly diagnosed as having asthma, he or she is often prescribed new medication without getting much information on the disease and its treatment. This article emphasizes the need to educate asthmatics. Asthma treatment should begin with a proper adjustment of the medication, allowing asthmatics to lead a normal life. All asthmatics should be shown how to use their inhalation device properly. They should he knowledgeable about the basic aspects of asthma, airway inflammation and bronchoconstriction, use or medication and early symptoms heralding an asthma attack. Environmental factors that may trigger an asthma attack should be explained. Patients should be able to self-monitor asthma using either symptom severity or a peak flow meter. Because asthma is an unpredictable disease, patients should have a self-action plan to implement when their asthma deteriorates.

  6. Asthma Management Disparities: A Photovoice Investigation with African American Youth

    Science.gov (United States)

    Evans-Agnew, Robin

    2016-01-01

    Disparities in asthma management are a burden on African American youth. The objective of this study is to describe and compare the discourses of asthma management disparities (AMDs) in African American adolescents in Seattle to existing youth-related asthma policies in Washington State. Adolescents participated in a three-session photovoice…

  7. Asthma in pregnancy: Physiology, diagnosis, and management.

    Science.gov (United States)

    Kelly, William; Massoumi, Ali; Lazarus, Angeline

    2015-05-01

    Asthma is a common, potentially serious, medical condition that affects an estimated 8% of pregnant patients, with 4% of all pregnant patients experiencing an exacerbation in the past year. Practitioners must be able to diagnose, educate, and treat such patients as they undergo significant physiological and immunologic change. But staying current can be challenging given over 3000 citations for "asthma and pregnancy" in a recent PubMed search, with 750 described as review articles. Patients have even more difficulty navigating information, with 29 million Google search results for this same query and 1.2 million alone for the question whether asthma medications are safe during pregnancy. This review provides brief answers to important management questions followed by supporting background literature.

  8. Recognition and surveillance of occupational asthma: a preventable illness with missed opportunities.

    Science.gov (United States)

    Hendrick, David J

    2010-01-01

    Occupational asthma is common, disabling and costly, and it is often difficult to diagnose. Incidence statistics are consequently unreliable, and there are formidable difficulties in recognizing and managing what should be a preventable illness. The opportunities have largely been missed. The author offers a personal view of what, ideally, should be done--recognizing that at present the ideal is not readily practical. Always consider the possibility of an occupational cause at the time adult-onset asthma is first recognized-the probability of this is of the order 9-15%. Do not prescribe treatment unless this possibility is remote or the asthma is life-threatening. If the possibility is not remote seek immediate advice from a specialized centre, without prescribing masking medication and without curtailing usual work practice. The specialized referral centre should place the accurate measurement of airway responsiveness at the centre of investigatory strategies. A return-to-work study, monitored by serial measurements of airway responsiveness and ventilatory function, provides adequate objective evidence for diagnosis in most cases. When a novel cause is suspected, specific inhalation provocation testing with the particular agent in the specialized centre is desirable. Regular competent surveillance is necessary in high-risk occupational environments; this should include environmental monitoring, the detection of relevant new symptoms, spirometry measurements, serum antibody studies (where available) and a robust protocol for managing inevitable failed attendances. PMID:20656698

  9. School Asthma Screening and Case Management: Attendance and Learning Outcomes

    Science.gov (United States)

    Moricca, Michelle L.; Grasska, Merry A.; BMarthaler, Marcia; Morphew, Tricia; Weismuller, Penny C.; Galant, Stanley P.

    2013-01-01

    Asthma is related to school absenteeism and underperformance in elementary students. This pilot study assessed whether school nurse case management (CM) in children identified with asthma impacts academic performance and school absenteeism in one school. A validated questionnaire was used to identify children at risk for asthma and CM was provided…

  10. Survey of the management of acute asthma in children.

    LENUS (Irish Health Repository)

    Widger, J

    2009-12-01

    Acute asthma is one of the most common reasons for children presenting to the emergency department. International guidelines for the management of acute paediatric asthma are widely available. In this study we examined how acute asthma in children is managed across hospitals in Ireland and compared Irish practice with standard international guidelines. We surveyed 54 paediatricians across 18 centres in Ireland. A total of 30 (55.5%) individual paediatricians across 17 (94%) centres replied. The majority of centres had a written protocol for the management of acute asthma. A large number of centres use MDI and spacer devices in acute management although doses used varied widely. Only 29% of centres had written asthma action plans available from the emergency department and 53% had plans available from the ward. Irish practice is largely inline with established guidelines. A national asthma strategy could further help to improve asthma care.

  11. Quality of asthma management in an urban community in Delhi, India

    OpenAIRE

    Kotwani, Anita; Chhabra, S. K.; Tayal, Vandana; Vijayan, V K

    2012-01-01

    Background & objectives: High prevalence and poor control of asthma make its management a major public health issue worldwide, especially in developing countries. Optimum review of asthma management in the community is essential to improve asthma control. This study was conducted to investigate the quality of asthma management, knowledge about asthma and quality of life of asthma patients referred to a public tertiary care chest hospital in Delhi. Methods: Diagnosis of asthma was confirmed by...

  12. Recognition and management of asthma in children and young people.

    Science.gov (United States)

    Pinfield, Jenny; Gaskin, Kerry; Bentley, Jackie; Rouse, Jo

    2015-09-16

    Asthma is a common childhood disorder that has global significance. Developing an understanding of the aetiology, effects, diagnosis and management of the disorder enables healthcare practitioners to reduce the physical, psychological and social effects of asthma on children, families and healthcare systems. This article refers to the Scottish Intercollegiate Guidelines Network and British Thoracic Society guideline on the management of asthma, and enables the reader to incorporate this guidance into their practice.

  13. 331 Asthma Management in Latin America: Learnings from the Latin America Asthma Insight and Management (LA AIM) Survey of Patients

    OpenAIRE

    Maspero, Jorge; Jardim, Jose; González-Díaz, Sandra; Aranda, Alvaro; Tassinari, Paolo

    2012-01-01

    Background In 2003, the Asthma Insights and Reality in Latin America (AIRLA) survey assessed, in part, perception, knowledge, and attitudes related to asthma.1 In 2011 the Latin America Asthma Insight and Management (LA AIM) survey was designed to ascertain the realities of living with asthma, disconnect between expectations in asthma management and patient experience, and unmet needs. Using results from our survey, we investigated the advances made in asthma care and the challenges that rema...

  14. Maternal complications and the management of asthma in pregnancy.

    Science.gov (United States)

    Vanders, Rebecca L; Murphy, Vanessa E

    2015-03-01

    Pregnancy is a unique state requiring alterations in maternal physiology to accommodate the growing fetus. Whilst the maternal immune system is normally well adept at performing this task, the presence of immune disorders, such as asthma, often lead to pregnancy-related complications affecting both mother and baby. Australia has a high prevalence of asthma; with approximately 12% of pregnant women reported to have current asthma. Poor control of asthma is of far greater risk than the use of asthma medications. Being able to identify complications associated with asthma during pregnancy is of great importance in providing appropriate asthma management and medical care to these pregnant women, which may have lifelong consequences for their offspring.

  15. The prevalence, management and burden of asthma - a Nigerian study.

    Science.gov (United States)

    Oni, Alexander O; Erhabor, G E; Egbagbe, E E

    2010-03-01

    Inadequate attention given to the management of asthma and ways of improving treatment could be a significant factor for the increase morbidity and mortality from asthma despite major advances in our understanding of the pathophysiology of the disease. There seems to be paucity of data concerning the management pattern and burden of asthma in Africa. This study was under taken to determine the prevalence, management pattern and the burden of asthma. This study was a cross sectional design involving clinical and lung function assessment. The diagnosis of asthma was made using the clinical features of asthma and lung function parameters (Forced expiratory volume in one second, Peak expiratory flow rate, Reversibility tests). Totally, 120 asthma patients participated in this study. All subjects completed the clinical asthma control questionnaires. All items were rated with the calculation of their mean and percentages. Student t-test was used to calculate the difference between the mean of the lung function tests for subjects and control. The prevalence of asthma among respiratory unit patients was 6.6% and higher in the first three decades of life with female preponderance (F:M=1.5-1).There is a strong family history of asthma(81.7%). Associated allergies include rhinitis (75%), pharyngitis (54%), conjunctivitis (54%) and dermatitis (30%). Percentage of asthma patients treated with bronchodilators alone (70%), combined inhaled bronchodilators and steroid (28.3%). Impaired daily activities include sports (84%), Job career (60%), Physical activity (55%), Social activity (54%), Household chores (61%), Disturbed sleep (53%), Daytime symptoms (51%), Hospitalized(50%). Subjects had significant low lung function values when compared with control (P asthma is very high despite the advanced knowledge of the pathophysiology and management of asthma.

  16. Internet-based self-management in asthma

    NARCIS (Netherlands)

    Meer, Victor van der

    2010-01-01

    This thesis describes the role of internet-based support in the delivery of an asthma self management program. First, the compliance and reliability of home lung function monitoring, one of the key features of asthma self-management, was studied and appeared to be high over a 4-week period. Second,

  17. Towards tailored and targeted adherence assessment to optimise asthma management

    NARCIS (Netherlands)

    van Boven, Job F. M.; Trappenburg, Jaap C. A.; van der Molen, Thys; Chavannes, Niels H.

    2015-01-01

    In this paper, we aim to emphasise the need for a more comprehensive and tailored approach to manage the broad nature of non-adherence, to personalise current asthma management. Although currently several methods are available to measure the extent of asthma patients' adherence, the vast majority do

  18. Emergency presentation and management of acute severe asthma in children

    OpenAIRE

    Øymar Knut; Halvorsen Thomas

    2009-01-01

    Abstract Acute severe asthma is one of the most common medical emergency situations in childhood, and physicians caring for acutely ill children are regularly faced with this condition. In this article we present a summary of the pathophysiology as well as guidelines for the treatment of acute severe asthma in children. The cornerstones of the management of acute asthma in children are rapid administration of oxygen, inhalations with bronchodilators and systemic corticosteroids. Inhaled bronc...

  19. Managing Asthma: Learning to Breathe Easier

    Science.gov (United States)

    ... Dr. Michelle Freemer, an NIH asthma expert. For youngsters, a doctor will do a physical exam and ... and treat asthma. Levine’s team is studying the effects of house dust mites inside the home. While ...

  20. Progress in the management of childhood asthma

    OpenAIRE

    Vichyanond, Pakit; Pensrichon, Rattana; Kurasirikul, Suruthai

    2012-01-01

    Asthma has become the most common chronic disease in childhood. Significant advances in epidemiological research as well as in therapy of pediatric asthma have been made over the past 2 decades. In this review, we look at certain aspects therapy of childhood asthma, both in the past and present. Literature review on allergen avoidance (including mites, cockroach and cat), intensive therapy with β2-agonists in acute asthma (administering via continuous nebulization and intravenous routes), a r...

  1. Managing Asthma in the Early Childhood Setting

    Science.gov (United States)

    Graville, Iris

    2011-01-01

    Asthma, one of the most common chronic disorders in childhood, affects more than seven million children in the United States, and is the third leading cause of hospitalization for children. Statistics like these make planning and preparing for asthma in the early childhood setting a high priority. With the high rates of asthma in the U.S. today,…

  2. Managing Risk and Opportunity

    DEFF Research Database (Denmark)

    Andersen, Torben Juul; Garvey, Maxine; Roggi, Oliviero

    outcomes. This topic is timely and of interest both to the academic community as well as to practicing managers, executives, and directors. The volume focuses on contemporary risk leadership issues based on recent research insights but avoids excessive technical language and mathematical formulas. The book...... is framed around the challenges imposed on executives and directors in dealing with an increasingly complex and unpredictable world. This requires a new risk leadership focus that not only avoids the downside risks but also considers ways to exploit the upside potential offered by a dynamic environment....... The underlying logic is built on the principles of financial economics where benefits derive from reducing bankruptcy costs and increasing future cash inflows. This provides a stringent framework for analyzing the effect of different risk management actions and behaviors in effective risk-taking organizations...

  3. Feasibility of Adapting Multisystemic Therapy to Improve Illness Management Behaviors and Reduce Asthma Morbidity in High Risk African American Youth: A Case Series

    Science.gov (United States)

    Naar-King, Sylvie; Ellis, Deborah; Kolmodin, Karen; Cunningham, Phillippe; Secord, Elizabeth

    2009-01-01

    African-American adolescents have the highest rates of asthma morbidity and mortality, yet there are few successful behavioral interventions to improve illness management for this group. Mental health providers have an opportunity to expand their services and impact by targeting adolescents with poor asthma management. We describe the adaptation…

  4. Crisis management: some opportunities.

    Science.gov (United States)

    Kupperman, R H; Wilcox, R H; Smith, H A

    1975-02-01

    Modern crises present decision makers with many agonizing management choices. Very often a crisis manager is confronted with a plethora of conflicting information and given very little time to choose an appropriate course of action. Although contemporary methods of systems analysis have been used in attempts to organize data and clarify options, they have generally been of little use in presenting an accurate picture of an opponent's values and perceptions. Thus it is clear that we must now make use of the improved communications and technological devices at our disposal if crises are to be avoided or resolved with minimum damage. Our proposal to establish international model-oriented computer-assisted conferences is designed to promote greater cooperation and understanding among scientists and crisis managers of differing nations by enabling them to share images of themselves and one another. With better information and more rational options available, the chances of catastrophic misunderstanding or miscalculation can be meaningfully reduced. We have proposed a possible scenario for the initial implementation of such a system to combat famine, and hope that the same approach might be used in other areas over time. The ultimate goal is a system by which specialists of all persuasions cooperate so that international crises will be resolved on the bases of mutual benefits without resort to armed conflict. PMID:17835296

  5. Examining Household Asthma Management Behavior through a Microeconomic Framework

    Science.gov (United States)

    Magzamen, Sheryl; Brandt, Sylvia J.; Tager, Ira B.

    2014-01-01

    National guidelines on the effective management of pediatric asthma have been promoted for over 20 years, yet asthma-related morbidity among low-income children remains disproportionately high. To date, household and clinical interventions designed to remediate these differences have been informed largely by a health behavior framework. However,…

  6. IAQ Tools for Schools: Managing Asthma in the School Environment.

    Science.gov (United States)

    Environmental Protection Agency, Washington, DC. Office of Radiation and Indoor Air.

    This manual provides tips on improving indoor air quality within the school environment by removing the elements that trigger asthma attacks in children, and presents a list of organizations where asthma resource information can be obtained. Air quality management tips cover removing of animal and cockroach allergens, cleaning up mold and…

  7. A NATIONAL POLICY ON ASTHMA MANAGEMENT FOR SCHOOLS

    NARCIS (Netherlands)

    MELLIS, CM; BOWES, G; HENRY, RL; MITCHELL, CA; PHELAN, PD; SHAH, S; SHAROTA, L; STAUGAS, R; SLY, PD; YOUNG, L

    1994-01-01

    Since asthma is the most common chronic illness in childhood, many of the problems associated with this condition will impact on the child's education. Because of widespread concerns regarding the management of asthma in schools, a subcommittee of the Thoracic Society of Australia and New Zealand, A

  8. Disparities in Asthma Care, Management, and Education Among Children With Asthma

    Science.gov (United States)

    Holsey, Chanda N.; Collins, Pamela; Zahran, Hatice

    2016-01-01

    Health disparities are pervasive in the United States. Health and health care disparities are the differences or gaps in health (eg, life expectancy, morbidity, risk factors, and quality of life) and health care access and quality between segments of the United States population as related to race/ethnicity and socioeconomic status (eg, income, education). Multiple factors are associated with such disparities in asthma management and education. This article explores some of those factors and summarizes the strategies developed and interventions implemented to address disparities associated with asthma care and education among racial and ethnic minority children. It also discusses the need for further research to identify effective asthma education approaches for improving the management of asthma among racial and ethnic minority children. More exploration of the root causes of health care disparities, including policy studies in the area of social determinates of health and health equity, is also needed.

  9. Asthma Prevalence, Management, and Education in New York State Elementary Schools: A Survey of School Nurses

    Science.gov (United States)

    Kielb, Christine; Lin, Shao; Hwang, Syni-an

    2007-01-01

    A survey of school nurses was conducted in New York State elementary schools to assess asthma and asthma management in students. The survey contained questions about asthma morbidity, management and education, obstacles to management, and school indoor air quality. The reported prevalence of asthma among students was 8.5%. Of the students with…

  10. Assessment of Controversial Pediatric Asthma Management Options Using GRADE

    NARCIS (Netherlands)

    Boluyt, Nicole; Rottier, Bart L.; de Jongste, Johan C.; Riemsma, Rob; Vrijlandt, Elianne J. L. E.; Brand, Paul L. P.

    2012-01-01

    OBJECTIVES: To develop explicit and transparent recommendations on controversial asthma management issues in children and to illustrate the usefulness of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach in rating the quality of evidence and strength of recommend

  11. Asthma

    Science.gov (United States)

    ... it as a kid. What Causes an Asthma Flare-Up? Anything that causes an asthma flare-up (attack) is called an asthma trigger. Different kids ... doctor will think about what causes the asthma flare-ups, how fast the flare-ups happen, and how ...

  12. A self management plan in the treatment of adult asthma.

    OpenAIRE

    Beasley, R; Cushley, M; Holgate, S T

    1989-01-01

    To determine whether routine assessment of peak expiratory flow (PEF) in association with a self management plan based on inhaled corticosteroid use is effective in the management of chronic asthma, 36 consecutive adult patients with asthma attending an outpatient chest clinic were admitted to an open prospective study. Patients were treated with inhaled salbutamol and beclomethasone dipropionate in an attempt to achieve normal lung function. Each patient had a "potential normal value," which...

  13. Optimising the management of patients with difficult asthma.

    Science.gov (United States)

    Palmer, Evelyn; Higgins, Bernard

    2015-11-01

    Asthma affects 5.4 million people in the UK, around 1 in 12 of the population. Between 5 and 10% of asthma (depending on the definition used) is categorised as difficult asthma, a term which generally refers to patients who continue to experience symptoms and frequent exacerbations despite the prescription of high-dose asthma therapy. Difficult asthma is an indication for specialist review by an appropriate respiratory physician, but close liaison between primary, secondary and tertiary care is critical and it is therefore important that primary care health professionals should be aware of the principles of management. One of the most important questions to ask is whether the individual with difficult asthma is taking their treatment Identifying this, however, is not easy. GPs could assess prescription uptake, looking for low use of preventers and excess use of short-acting bronchodilators. Newer means of assessing adherence have been developed. Inhaler devices that can monitor completion and timing of actuations have been produced. Meters that measure FeNO are available. A recent UK study found that 12 out of 100 patients referred for difficult asthma did not have reversible airflow obstruction or a history suggestive of asthma. Diagnoses included COPD, cystic fibrosis, cardiomyopathy, respiratory muscle dysfunction and severe anxiety with vocal cord dysfunction.

  14. Concise guidance: diagnosis, management and prevention of occupational asthma.

    Science.gov (United States)

    Nicholson, Paul J; Cullinan, Paul; Burge, Sherwood

    2012-04-01

    This concise guidance, prepared for physicians, summarises the British Occupational Health Research Foundation guideline for the prevention, identification and management of occupational asthma. Approximately one in six people of working age who develop asthma have work-related asthma, where work has either caused or aggravated their disease. Physicians who assess working adults with asthma need to ask the patient about their job and the materials they work with, and be aware of those that carry particular risks; they should also ask whether symptoms improve regularly on days away from work. A diagnosis of occupational asthma (ie asthma caused by work) should not be made on the basis of history alone, but be supported by immunological and physiological investigations of proven diagnostic benefit. Following a validated diagnosis of occupational asthma, physicians should recommend early avoidance of further exposure, because this offers the best chance of complete recovery. If appropriate and timely interventions are not taken, the prognosis of occupational asthma is poor, with only approximately one-third of workers achieving full symptomatic recovery.

  15. Compliance amongst asthma patients registered for an asthma disease risk-management programme in South Africa.

    Science.gov (United States)

    Opedun, Ntombombuso; Ehlers, Valerie J; Roos, Janetta H

    2011-09-27

    The study attempted to identify the factors that influence compliance amongst 1039 members and their dependants of a particular medical aid scheme in South Africa who were registered for an asthma disease risk-management (DRM) programme. The sample consisted of 200 systematically selected individuals or their dependants. A quantitative, exploratory, and descriptive study was undertaken. Questionnaires for completion were posted to the individuals or their dependants. The Statistica 7.1 computer program was used to analyse the data.Most asthma patients did not comply with the DRM programme because they lacked knowledge of the programme. Asthma patients' compliance with the DRM programme can be enhanced by the sustained, positive attitudes of their health providers and case managers; better promotion of the programme; and by involving the patients to a greater extent in the long-term management of their disease.Asthma patients require education about healthy lifestyles that would empower them to successfully manage their condition, which would prevent or at least reduce asthma attacks and/or hospital admissions.

  16. Compliance amongst asthma patients registered for an asthma disease risk-management programme in South Africa

    Directory of Open Access Journals (Sweden)

    Ntombombuso Opedun

    2011-09-01

    Full Text Available The study attempted to identify the factors that influence compliance amongst 1039 members and their dependants of a particular medical aid scheme in South Africa who were registered for an asthma disease risk-management (DRM programme. The sample consisted of 200 systematically selected individuals or their dependants. A quantitative, exploratory, and descriptive study was undertaken. Questionnaires for completion were posted to the individuals or their dependants. The Statistica 7.1 computer program was used to analyse the data.Most asthma patients did not comply with the DRM programme because they lacked knowledge of the programme. Asthma patients’ compliance with the DRM programme can be enhanced by the sustained, positive attitudes of their health providers and case managers; better promotion of the programme; and by involving the patients to a greater extent in the long-term management of their disease.Asthma patients require education about healthy lifestyles that would empower them to successfully manage their condition, which would prevent or at least reduce asthma attacks and/or hospital admissions.

  17. Management of asthma: the current US and European guidelines.

    Science.gov (United States)

    Reddy, Ashwini P; Gupta, Meera R

    2014-01-01

    Asthma management guidelines aim to improve the implementation of current knowledge into daily clinical practice by establishing a consensus of scientific practices for the management of asthma. Initial guidelines were based on consensus of expert opinion in order to employ a severity-based classification system as a guide to treatment. However, advances in asthma research led to the development of evidence-based guidelines and a major paradigm shift to control-based asthma management. Control-based management is central to the published guidelines developed by The National Heart, Lung, and Blood Institute (NHLBI), The Global Initiative for Asthma (GINA), and The British Thoracic Society (BTS), each one using the same volume of evidence but emphasizing aspects particular to their specific patient populations and socioeconomic needs. This chapter summarizes the evolution of these guidelines and summarizes the key points and evidence used in the recommendations for the assessment, monitoring, and management of asthma in all ages, with particular emphasis on the NHLBI guidelines.

  18. Self-management program in treatment of asthma

    Directory of Open Access Journals (Sweden)

    Milenković Branislava

    2007-01-01

    Full Text Available Introduction. Recently published national and international guidelines stress the importance of self-management in asthma. They have recommended that self-management plans should be an essential part of the long-term management of asthmatic patients. These plans essentially focus on the early recognition of unstable or deteoriorating asthma, by monitoring peak flow or symptoms. Objective. The aim of our one-year study was to compare the efficacy of peak-flow based self-management of asthma with traditional treatment. Method. Sixty clinically stable adult patients with mild and moderate persistent asthma were randomly allocated to peakflow based self-management (Group A, n=30 or to conventional treatment (Group B, n=30, with no significant difference between groups in terms of age, sex distribution and initial lung function. The recorded measurements were: lung function, asthma exacerbations, unscheduled ambulatory care facilities (hospital-based emergency department, consultations with general practitioner or pulmonologist, courses of oral prednisolone, courses of antibiotics, days off work. Results. There was a significant difference between groups in number of asthma exacerbations (p<0.05, unscheduled visits to ambulatory care facilities (p<0.005, days off work (p<0.0001, courses of oral prednisolone (p<0.001 and antibiotics (p<0.05. At the final visit, there was a significant improvement in some measurements of asthma severity in group A (reduced unscheduled visits for ambulatory care, reduced treatment requirements for oral corticosteroids and antibiotics, reduced days off work, but a lack of statistical difference in lung function and the maintenance-inhaled corticosteroid dose. There was no significant change in group B. Conclusion. These results suggest that peak-flow based self management is more effective than traditonal treatment in mild and moderate persistent asthma. .

  19. Management of critical asthma syndrome during pregnancy.

    Science.gov (United States)

    Chan, Andrew L; Juarez, Maya M; Gidwani, Nisha; Albertson, Timothy E

    2015-02-01

    One-third of pregnant asthmatics experience a worsening of their asthma that may progress to a critical asthma syndrome (CAS) that includes status asthmaticus (SA) and near-fatal asthma (NFA). Patients with severe asthma before pregnancy may experience more exacerbations, especially during late pregnancy. Prevention of the CAS includes excellent asthma control involving targeted early and regular medical care of the pregnant asthmatic, together with medication compliance. Spontaneous abortion risk is higher in pregnant women with uncontrolled asthma than in non-asthmatics. Should CAS occur during pregnancy, aggressive bronchodilator therapy, montelukast, and systemic corticosteroids can be used in the context of respiratory monitoring, preferably in an Intensive Care Unit (ICU). Systemic epinephrine should be avoided due to potential teratogenic side-effects and placental/uterine vasoconstriction. Non-invasive ventilation has been used in some cases. Intratracheal intubation can be hazardous and rapid-sequence intubation by an experienced physician is recommended. Mechanical ventilation parameters are adjusted based on changes to respiratory mechanics in the pregnant patient. An inhaled helium-oxygen gas admixture may promote laminar airflow and improve gas exchange. Permissive hypercapnea is controversial, but may be unavoidable. Sedation with propofol which itself has bronchodilating properties is preferred to benzodiazepines. Case reports delineating good outcomes for both mother and fetus despite intubation for SA suggest that multidisciplinary ICU care of the pregnant asthmatic with critical asthma are feasible especially if hypoxemia is avoided.

  20. Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma-Summary Report 2007.

    Science.gov (United States)

    2007-11-01

    instructions for daily treatment and ways to recognize and handle worsening asthma. New recommendations encourage expanding educational opportunities to reach patients in a variety of settings, such as pharmacies, schools, community centers, and patients' homes. A new section addresses the need for clinician education programs to improve communication with patients and to use system-wide approaches to integrate the guidelines into health care practice. The guidelines describe new evidence for using multiple approaches to limit exposure to allergens and other substances that can worsen asthma; research shows that single steps are rarely sufficient. EPR-3 also expands the section on common conditions that can affect asthma and notes that management of these conditions may help to improve asthma control. Expert Panel Report 3 continues the use of a stepwise approach to control asthma. When assessing the level of asthma control to determine the need for adjusting therapy, EPR-3 reconfirms the importance of assessing patient adherence to medication, inhaler technique, and environmental control measures before making a step up in therapy. The stepwise approach expands from 4 steps to 6 steps of care. Medications have been repositioned within these 6 steps. Recommendations on medications are updated to reflect the latest evidence on effectiveness and safety. EPR-3 reaffirms that patients with persistent asthma need both long-term control medications to control asthma and prevent exacerbations and quick-relief medication for symptoms, as needed. EPR-3 also reaffirms that inhaled corticosteroids are the most effective long-term control medication across all age groups. New recommendations on treatment options such as leukotriene receptor antagonists and cromolyn for long-term control; long-acting beta-agonists as adjunct therapy with inhaled corticosteroids; omalizumab for severe asthma; and albuterol, levalbuterol, and corticosteroids for acute exacerbations are included. PMID

  1. Leukotriene modifiers in pediatric asthma management

    DEFF Research Database (Denmark)

    Bisgaard, H

    2001-01-01

    Cysteinyl leukotrienes (Cys-LTs) are mediators released in asthma and virus-induced wheezing. Corticosteroids appear to have little or no effect on this release in vivo. Cys-LTs are both direct bronchoconstrictors and proinflammatory substances that mediate several steps in the pathophysiology...... of chronic asthma, including inflammatory cell recruitment, vascular leakage, and possibly airway remodeling. Blocking studies show that Cys-LTs are pivotal mediators in the pathophysiology of asthma. Cys-LTs are key components in the early and late allergic airway response and also contribute to bronchial...... obstruction after exercise and hyperventilation of cold, dry air in asthmatics. LT modifiers reduce airway eosinophil numbers and exhaled nitric oxide levels. Together these findings support an important role for the Cys-LTs in the asthma airway inflammation. Cys-LT receptor antagonists (Cys...

  2. Acute asthma: emergency department management and prospective evaluation of outcome.

    OpenAIRE

    Fitzgerald, J M; Hargreave, F. E.

    1990-01-01

    To determine the current management of acute asthma in the emergency department and to evaluate outcome we reviewed the charts of 99 patients aged 15 to 55 years who presented to the emergency department of a tertiary referral, university-affiliated hospital and were subsequently discharged with a diagnosis of acute asthma. Outcome was evaluated prospectively, with a structured questionnaire, by telephone. During the visit pulsus paradoxus was documented in four patients. Spirometry was done ...

  3. Asthma

    Science.gov (United States)

    ... by allergens or physical activity. Occasionally, doctors use X-rays to diagnose asthma. Doctors treat each asthma case ... them. If you get flare-ups during a game or workout, stop what you're doing until ...

  4. Asthma management in pregnancy: young female doctors knowledge and practice

    International Nuclear Information System (INIS)

    Background: Optimal asthma control in pregnant women is very much essential for the good health of both mother and the fetus. Maternal and fetal complications occur due to poor control of asthma. There are concerns that management of bronchial asthma in pregnant women should be optimal by the health professionals. Objective: The aim of the study was to evaluate the knowledge and practices of young female doctors about the bronchial asthma management in pregnancy. Study Design: Randomized evidence based. Study Setting: Punjab Public Service Commission (PPSC) interviews for women medical officers and female doctors working in different medical units and chest unit of Mayo Hospital a tertiary care hospital affiliated with King Edward Medical University, Lahore. Materials and Methods: A questionnaire based survey of knowledge and practices of one hundred and one female doctors in the management of bronchial asthma was made. Amongst these, 32 doctors were FCPS 1 in medicine and gynecology. Remaining 69 doctors were in the pipeline and they have completed one year house job in different specialties. The case scenario was Asthma management approach during pregnancy in a stable patient of moderate severity. Inclusion Criteria 1. All those female doctors who have completed one year house job. 2. Female doctors working in gynecology, medicine, surgery and allied specialties. Results: Overall 14 (13.6%) doctors (5 (35.7%) PGs and 9 (64.3%) Non PGs) have the standard prescription of inhaled corticosteroids with long acting inhaled B2 agonists and montelukast as controller medication and short acting inhaled B2 agonist as needed as reliever medication according to the standard guidelines. Conclusion: The majority of young female doctors had the suboptimal knowledge and practice of asthma management in pregnancy. We suggest initiating the training programs to optimize their knowledge and practices. (author)

  5. The management of work-related asthma guidelines: a broader perspective

    NARCIS (Netherlands)

    Baur, X.; Aasen, T.B.; Burge, P.S.; Heederik, D.

    2012-01-01

    The aim of the European Respiratory Society work-related asthma guidelines is to present the management and prevention options of work-related asthma and their effectiveness. Work-related asthma accounts for 5-25% of all adult asthma cases and is responsible for a significant socioeconomic burden. S

  6. Diagnosis and management of asthma in older adults.

    LENUS (Irish Health Repository)

    Chotirmall, Sanjay Haresh

    2009-05-01

    Despite comprehensive guidelines established by the European Global Initiative for Asthma and the U.S. National Asthma Education and Prevention Program on the diagnosis and management of asthma, its mortality in older adults continues to rise. Diagnostic and therapeutic problems contribute to older patients being inadequately treated. The diagnosis of asthma rests on the history and characteristic pulmonary function testing (PFT) with the demonstration of reversible airway obstruction, but there are unique problems in performing this test in older patients and in its interpretation. This review aims to address the difficulties in performing and interpreting PFT in older patients because of the effects of age-related changes in lung function on respiratory physiology. The concept of "airway remodeling" resulting in "fixed obstructive" PFT and the relevance of atopy in older people with asthma are assessed. There are certain therapeutic issues unique to older patients with asthma, including the increased probability of adverse effects in the setting of multiple comorbidities and issues surrounding effective drug delivery. The use of beta 2-agonist, anticholinergic, corticosteroid, and anti-immunoglobulin E treatments are discussed in the context of these therapeutic issues.

  7. Wheezing and Asthma in Infants

    Science.gov (United States)

    ... Cooperate While Using the Nebulizer? Handling an Asthma Flare-Up What's an Asthma Flare-Up? Asthma Center Asthma Basics Managing Asthma When Your ... a Health Problem Asthma Center Handling an Asthma Flare-Up How Do Asthma Medicines Work? Asthma Asthma Center ...

  8. Emergency presentation and management of acute severe asthma in children

    Directory of Open Access Journals (Sweden)

    Øymar Knut

    2009-09-01

    Full Text Available Abstract Acute severe asthma is one of the most common medical emergency situations in childhood, and physicians caring for acutely ill children are regularly faced with this condition. In this article we present a summary of the pathophysiology as well as guidelines for the treatment of acute severe asthma in children. The cornerstones of the management of acute asthma in children are rapid administration of oxygen, inhalations with bronchodilators and systemic corticosteroids. Inhaled bronchodilators may include selective b2-agonists, adrenaline and anticholinergics. Additional treatment in selected cases may involve intravenous administration of theophylline, b2-agonists and magnesium sulphate. Both non-invasive and invasive ventilation may be options when medical treatment fails to prevent respiratory failure. It is important that relevant treatment algorithms exist, applicable to all levels of the treatment chain and reflecting local considerations and circumstances.

  9. Tailored Education May Reduce Health Literacy Disparities in Asthma Self-Management

    OpenAIRE

    Paasche-Orlow, Michael K; Riekert, Kristin A; Bilderback, Andrew; Chanmugam, Arjun; Hill, Peter; Rand, Cynthia S.; Brancati, Fred L.; Krishnan, Jerry A.

    2005-01-01

    Rationale: Although inadequate health literacy has been associated with lower asthma medication knowledge and worse metered-dose inhaler (MDI) technique, the relationship between health literacy and the capacity to learn asthma self-management skills is unknown.

  10. Recommendation for optimal management of severe refractory asthma

    Directory of Open Access Journals (Sweden)

    Jaymin B Morjaria

    2010-07-01

    Full Text Available Jaymin B Morjaria1, Riccardo Polosa21Department of IIR, University of Southampton, Southampton, UK; 2Dipartimento di Medicina Interna e Specialistica, University of Catania, Catania, ItalyAbstract: Patients whose asthma is not adequately controlled despite treatment with a ­combination of high dose inhaled corticosteroids and long-acting bronchodilators pose a major clinical challenge and an important health care problem. Patients with severe refractory disease often require regular oral corticosteroid use with an increased risk of steroid-related adverse events. Alternatively, immunomodulatory and biologic therapies may be considered, but they show wide variation in efficacy across studies thus limiting their generalizability. Managing asthma that is refractory to standard treatment requires a systematic approach to evaluate ­adherence, ensure a correct diagnosis, and identify coexisting disorders and trigger factors. In future, ­phenotyping of patients with severe refractory asthma will also become an ­important element of this systematic approach, because it could be of help in guiding and tailoring ­treatments. Here, we propose a pragmatic management approach in diagnosing and treating this challenging subset of asthmatic patients.Keywords: severe asthma, corticosteroids, immunological modifiers, steroid-sparing, ­anti-TNF-a drugs, omalizumab, mepolizumab, daclizumab, bronchial thermoplasty

  11. Moving towards effective chronic illness management: asthma as an exemplar.

    Science.gov (United States)

    Estes, Tracy S

    2011-01-01

    The United States health care system is at a pivotal point in its ability to manage chronic illness. The demands and philosophical differences between the management of acute and chronic illnesses suggest the need for different strategies for effective and efficient management of chronic illness. The purpose of this article is to discuss the Chronic Care Model and the collaborative approach to managing chronic illnesses. Asthma, as an exemplar, will be used to illustrate the need for the development of new models of collaborative care for the treatment of chronic illnesses.

  12. The Saudi Initiative for Asthma - 2016 update: Guidelines for the diagnosis and management of asthma in adults and children

    Directory of Open Access Journals (Sweden)

    Mohamed S Al-Moamary

    2016-01-01

    Full Text Available This is an updated guideline for the diagnosis and management of asthma, developed by the Saudi Initiative for Asthma (SINA group, a subsidiary of the Saudi Thoracic Society. The main objective of SINA is to have guidelines that are up to date, simple to understand and easy to use by nonasthma specialists, including primary care and general practice physicians. SINA approach is mainly based on symptom control and assessment of risk as it is the ultimate goal of treatment. The new SINA guidelines include updates of acute and chronic asthma management, with more emphasis on the use of asthma control in the management of asthma in adults and children, inclusion of a new medication appendix, and keeping consistency on the management at different age groups. The section on asthma in children is rewritten and expanded where the approach is stratified based on the age. The guidelines are constructed based on the available evidence, local literature, and the current situation in Saudi Arabia. There is also an emphasis on patient–doctor partnership in the management that also includes a self-management plan.

  13. Summary of the 2008 BTS/SIGN British Guideline on the management of asthma.

    Science.gov (United States)

    Levy, Mark L; Thomas, Mike; Small, Iain; Pearce, Linda; Pinnock, Hilary; Stephenson, Paul

    2009-01-01

    The 2008 BTS/SIGN British Guideline on the management of asthma provides comprehensive updated evidence-based guidance on asthma management for healthcare professionals. This primary care-focussed summary has been produced to aid dissemination and implementation of the key guideline messages into primary care. The section on diagnosis emphasises the new integrated symptom-based approach with clinicians using their deductive skills to determine the probability that the patient has asthma. The various tools used for monitoring asthma are discussed. There are sections on both non-pharmacological and pharmacological management of chronic asthma in adults and children. Treatment options for children are subdivided into the under-5s and children aged 5-12 years. Poor asthma control is manifested by exacerbations and acute asthma. Personalised asthma action plans for guided self management should be provided and used when levels of asthma control change. There are sections on difficult asthma and the treatment of exacerbations and acute severe asthma. Various outcome measures for auditing the quality of asthma care are discussed.

  14. Role of herbs in the management of asthma

    Directory of Open Access Journals (Sweden)

    Ranjeeta Prasad

    2009-01-01

    Full Text Available Herbs have been the highly esteemed source of medicine throughout human history. They are widely used today indicating that herbs are a growing part of modern, high-tech medicine. About 25-30 percent of today′s prescription drugs contain chemical moieties derived from plants. The Indian system of medicine i.e Ayurveda alongwith classic texts like Bheshajya Ratnavali has a long-standing tradition that offers a unique insight into comprehensive approach to asthma management through proper care of the respiratory tract. Ayurvedic formulations used in the management of asthma, therefore, judiciously combine herbs to support the physiology of respiration, these herbs apart from exerting bronchial action also possess concomitant properties like anti-oxidant to support the digestive, cardiac, nerve functions and expectorant as well as just plain soothing herbs. Scientifically explored exhaustive reports have been published in Indian and International journals. Some of these herbs and their active chemical constituents which have a role in the management of asthma are compiled here and discussed in this review.

  15. Obesity and asthma: Pathophysiology and implications for diagnosis and management in primary care

    Science.gov (United States)

    Mohanan, Sveta; McWilliams, Andrew; Dulin, Michael

    2014-01-01

    The effects of obesity on asthma diagnosis, control, and exacerbation severity are increasingly recognized; however, the underlying pathophysiology of this association is poorly understood. Mainstream clinical practice has yet to adopt aggressive management of obesity as a modifiable risk factor in asthma care, as is the case with a risk factor like tobacco or allergen exposure. This review summarizes existing data that support the pathophysiologic mechanisms underlying the association between obesity and asthma, as well as the current and future state of treatment for the obese patient with asthma. Our review suggests that evidence of chronic inflammatory response linking obesity and asthma indicates a need to address obesity during asthma management, possibly using patient-centered approaches such as shared decision making. There is a need for research to better understand the mechanisms of asthma in the obese patient and to develop new therapies specifically targeted to this unique patient population. PMID:24719380

  16. Asthma management in British South Asian children: an application of the candidacy framework to a qualitative understanding of barriers to effective and accessible asthma care

    OpenAIRE

    Hudson, Nicky; Culley, Lorraine; Johnson, Mark; McFeeters, Melanie; Robertson, Noelle; Angell, Emma; Lakhanpaul, Monica

    2016-01-01

    Background In the UK, people of South Asian origin with asthma experience excess morbidity, with hospitalisation rates three times those of the majority White population and evidence suggests that South Asian children with asthma are more likely to suffer uncontrolled symptoms and hospital admissions with acute asthma compared to White British children. This paper draws on data from The Management and Interventions for Asthma (MIA) study to identify the operation of barriers to optimal care a...

  17. Are high generalised and asthma-specific self-efficacy predictive of adequate self-management behaviour among adult asthma patients?

    OpenAIRE

    Palen, van der, Job; Klein, Jakob J.; Seydel, Erwin R

    1997-01-01

    In asthma self-management training, often self-treatment guidelines are included, because increased knowledge of asthma alone is not sufficient to change behaviour. One way to achieve behavioural changes is by increasing the patient's general and asthma-specific self-efficacy expectancies. This refers to beliefs in one's capabilities to execute the recommended course of action successfully. We wanted to assess whether high generalised and asthma-specific self-efficacy expectancies were predic...

  18. Update on perioperative management of the child with asthma

    Directory of Open Access Journals (Sweden)

    Francesco Dones

    2012-04-01

    Full Text Available Asthma represents the leading cause of morbidity from a chronic disease among children. Dealing with this disease during the perioperative period of pediatric surgical procedures is, therefore, quite common for the anesthesiologist and other professionalities involved. Preoperative assessment has a key role in detecting children at increased risk of perioperative respiratory complications. For children without an optimal control of symptoms or with a recent respiratory tract infection elective surgery should be postponed, if possible, after the optimization of therapy. According to clinical setting, loco-regional anesthesia represents the desirable option since it allows to avoid airway instrumentation. Airway management goals are preventing the increase of airflow resistance during general anesthesia along with avoiding triggers of bronchospasm. When their use is possible, face mask ventilation and laringeal mask are considered more reliable than tracheal intubation for children with asthma. Sevoflurane is the most commonly used anesthetic for induction and manteinance. Salbutamol seems to be useful in preventing airflow resistance rise after endotracheal intubation. Mechanical ventilation should be tailored according to pathophysiology of asthma: an adequate expiratory time should be setted in order to avoid a positive end-expiratory pressure due to expiratory airflow obstruction. Pain should be prevented and promptly controlled with a loco-regional anesthesia technique when it is possible. Potential allergic reactions to drugs or latex should always be considered during the whole perioperative period. Creating a serene atmosphere should be adopted as an important component of interventions in order to guarantee the best care to the asthmatic child.

  19. Update on perioperative management of the child with asthma.

    Science.gov (United States)

    Dones, Francesco; Foresta, Grazia; Russotto, Vincenzo

    2012-04-01

    Asthma represents the leading cause of morbidity from a chronic disease among children. Dealing with this disease during the perioperative period of pediatric surgical procedures is, therefore, quite common for the anesthesiologist and other professionalities involved. Preoperative assessment has a key role in detecting children at increased risk of perioperative respiratory complications. For children without an optimal control of symptoms or with a recent respiratory tract infection elective surgery should be postponed, if possible, after the optimization of therapy. According to clinical setting, loco-regional anesthesia represents the desirable option since it allows to avoid airway instrumentation. Airway management goals are preventing the increase of airflow resistance during general anesthesia along with avoiding triggers of bronchospasm. When their use is possible, face mask ventilation and laringeal mask are considered more reliable than tracheal intubation for children with asthma. Sevoflurane is the most commonly used anesthetic for induction and manteinance. Salbutamol seems to be useful in preventing airflow resistance rise after endotracheal intubation. Mechanical ventilation should be tailored according to pathophysiology of asthma: an adequate expiratory time should be setted in order to avoid a positive end-expiratory pressure due to expiratory airflow obstruction. Pain should be prevented and promptly controlled with a loco-regional anesthesia technique when it is possible. Potential allergic reactions to drugs or latex should always be considered during the whole perioperative period. Creating a serene atmosphere should be adopted as an important component of interventions in order to guarantee the best care to the asthmatic child.

  20. A review of omalizumab for the management of severe asthma

    Science.gov (United States)

    Lin, Ching-Hsiung; Cheng, Shih-Lung

    2016-01-01

    Despite the expansion of the understanding in asthma pathophysiology and the continual advances in disease management, a small subgroup of patients remain partially controlled or refractory to standard treatments. Upon the identification of immunoglobulin E and other inflammatory mediators, investigations and developments of targeted agents have thrived. Omalizumab is a humanized monoclonal antibody that specifically targets the circulating immunoglobulin E, which in turn impedes and reduces subsequent releases of the proinflammatory mediators. In the past decade, omalizumab has been proven to be efficacious and well-tolerated in the treatment of moderate-to-severe asthma in both trials and real-life studies, most notably in reducing exacerbation rates and corticosteroid use. While growing evidence has demonstrated that omalizumab may be potentially beneficial in treating other allergic diseases, its indication remains confined to treating severe allergic asthma and chronic idiopathic urticaria. Future efforts may be focused on determining the optimal length of omalizumab treatment, seeking biomarkers that could better predict treatment response, as well as extending its indications. PMID:27528798

  1. A review of omalizumab for the management of severe asthma

    Directory of Open Access Journals (Sweden)

    Lin CH

    2016-07-01

    Full Text Available Ching-Hsiung Lin,1–3 Shih-Lung Cheng4,5 1Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan, Republic of China; 2Department of Respiratory Care, College of Health Sciences, Chang Jung Christian University, Tainan, Taiwan, Republic of China; 3School of Medicine, Chung Shan Medical University, Taichung, Taiwan, Republic of China; 4Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan, Republic of China; 5Department of Chemical Engineering and Materials Science, Yuan Ze University, Zhongli City, Taoyuan County, Taiwan, Republic of China Abstract: Despite the expansion of the understanding in asthma pathophysiology and the continual advances in disease management, a small subgroup of patients remain partially controlled or refractory to standard treatments. Upon the identification of immunoglobulin E and other inflammatory mediators, investigations and developments of targeted agents have thrived. Omalizumab is a humanized monoclonal antibody that specifically targets the circulating immunoglobulin E, which in turn impedes and reduces subsequent releases of the proinflammatory mediators. In the past decade, omalizumab has been proven to be efficacious and well-tolerated in the treatment of moderate-to-severe asthma in both trials and real-life studies, most notably in reducing exacerbation rates and corticosteroid use. While growing evidence has demonstrated that omalizumab may be potentially beneficial in treating other allergic diseases, its indication remains confined to treating severe allergic asthma and chronic idiopathic urticaria. Future efforts may be focused on determining the optimal length of omalizumab treatment, seeking biomarkers that could better predict treatment response, as well as extending its indications. Keywords: severe asthma, IgE, omalizumab, exacerbation, chronic idiopathic urticarial, inhaled corticosteroid

  2. Barriers to Asthma Self-Management in Adolescents: Relationships to Psychosocial Factors

    OpenAIRE

    Rhee, Hyekyun; Belyea, Michael J.; Ciurzynski, Susan; Brasch, Judith

    2009-01-01

    Asthma morbidity in adolescents often results from inadequate asthma self-management. This study was to explore barriers to self-management perceived by adolescents and to examine the associations between barriers and psychosocial factors including knowledge, attitude and self-efficacy. This cross-sectional study included a total of 126 adolescents with asthma (13–21 years) representing diverse race/ethnicity groups with a wide range of socioeconomic status. Self-reported data were analyzed u...

  3. Canadian Thoracic Society 2012 Guideline Update: Diagnosis and Management of Asthma in Preschoolers, Children and Adults

    Directory of Open Access Journals (Sweden)

    M Diane Lougheed

    2012-01-01

    Full Text Available BACKGROUND: In 2010, the Canadian Thoracic Society (CTS published a Consensus Summary for the diagnosis and management of asthma in children six years of age and older, and adults, including an updated Asthma Management Continuum. The CTS Asthma Clinical Assembly subsequently began a formal clinical practice guideline update process, focusing, in this first iteration, on topics of controversy and/or gaps in the previous guidelines.

  4. Asthma in elite athletes: how do we manage asthma-like symptoms and asthma in elite athletes?

    DEFF Research Database (Denmark)

    Lund, Thomas Kromann

    2009-01-01

    -asthmatic medication was currently taken by 24 (7%) elite athletes. Elite athletes participating in endurance sports had higher prevalences of asthma-like symptoms (74%), use of anti-asthmatic medication (15%) and current asthma (24%) than all other athletes (P

  5. Guidelines for asthma management: a review and comparison of 5 current guidelines.

    Science.gov (United States)

    Myers, Timothy R

    2008-06-01

    The first clinical practice guidelines for the assessment and management of asthma were published over 20 years ago in New Zealand and Australia. During the same period, British and Scottish groups were collaborating on a United Kingdom version of asthma guidelines. Shortly after the introduction of the New Zealand and Canadian guidelines, the National Heart, Lung, and Blood Institute of the United States National Institutes of Health participated in 2 additional asthma guideline endeavors, which were published in the early 1990s. The National Heart, Lung, and Blood Institute formed the National Asthma Education and Prevention Program to develop asthma guidelines for the United States, and participated with an international task force to develop guidelines for the treatment of asthma in all countries, which resulted in the formation of the Global Initiative for Asthma in the mid-1990s. The asthma guidelines issued by professional societies and other groups prior to the late 1990s were primarily based on consensus or expert opinion in each guideline committee, though those opinions were based on the available studies. The early guidelines played a vital role in bridging the gap between various treatment options and recent discoveries in basic science, and served as the vehicle to implementation into daily clinical practice. Asthma guidelines have been published and revised in dozens of countries around the world and have become reputable directives or "road maps" in asthma diagnosis, treatment, and management for patients of all ages. The guidelines have similar formats. The dissemination and implementation of the early guidelines was inconsistent, and they were criticized for not being evidence-based. As the knowledge of asthma pathophysiology continues to expand, along with basic science research on asthma diagnosis, treatment, and management, as well as education of the asthma patient, it is essential that the asthma guidelines be frequently updated and based on

  6. Do United States’ Teachers Know and Adhere to the National Guidelines on Asthma Management in the Classroom? A Systematic Review

    OpenAIRE

    Yudilyn Jaramillo; Marina Reznik

    2015-01-01

    Proper asthma management in schools is important in achieving optimum asthma control in children with asthma. The National Heart, Lung, and Blood Institute (NHLBI) has developed guidelines on classroom asthma management. We conducted a systematic review to examine teacher knowledge of the NHLBI guidelines on asthma management in the classroom. We searched PubMed and EMBASE using search terms “asthma management,” “teacher(s),” “school teacher,” and “public school.” The inclusion criteria were ...

  7. Guidance on the diagnosis and management of asthma among adults in resource limited settings

    NARCIS (Netherlands)

    Kirenga, Bruce J.; Schwartz, Jeremy I.; de Jong, Corina; van der Molen, Thys; Okot-Nwang, Martin

    2015-01-01

    BACKGROUND: Optimal management of asthma in resource limited settings is hindered by lack of resources, making it difficult for health providers to adhere to international guidelines. The purpose of this review is to identify steps for asthma diagnosis and management in resource limited settings. ME

  8. For Parents of Children with Asthma

    Science.gov (United States)

    ... Asthma > Managing Asthma For Parents of Children with Asthma Your Child's Asthma: A Parent's Guide to Better Breathing This step- ... health considerations you should keep in mind. Diagnosing Asthma in Young Children Most children who have asthma ...

  9. INTERRUPTER RESISTANCE IN PRESCHOOL CHILDREN: CLINICAL UTILITY IN ASTHMA MANAGEMENT

    Directory of Open Access Journals (Sweden)

    G. Boddi

    2012-12-01

    Full Text Available Asthma is the most common chronic disease affecting children in industrialized countries but it is greatly underdiagnosed in preschool children. In these patients, who are not able to collaborate in the execution of spirometry tests, it is possible to use interrupter resistance (Rint technique. The aim of our study is to assess Rint utility in asthma management when integrated with clinical evaluation in preschool children. Data from 35 preschool children with recurrent wheezing and/or cough were collected. Case history, physical examination, in vitro and in vivo allergy testing were investigated. According to the presence or absence of symptoms in intercritical period they were divided into two groups, asymptomatic (A and symptomatic (B. To assess respiratory function we used baseline and post-bronchodilator Rint. In group A (asymptomatic baseline Rint was normal in 78,9% of children and increased in 21,1%. After bronchodilator (BD administration there was a significant response in 52,6% of patients. In group B (symptomatic baseline Rint was normal in 81,3% of children and increased in 18,7%. After bronchodilator administration there was a significant response in 56,3% of patients. Our results confirm that baseline Rint cannot be used to discriminate between healthy and sick children, therefore it is necessary to perform this test after administration of BD. In our patients, a significant response to BD permitted to objectify the discomfort of symptomatic children and to report a state of subclinical bronchial obstruction and/or bad perceptions of the severity of bronchospasm in asymptomatic ones, allowing to confirm previous therapeutic choices in some cases and to suggest different therapeutic strategies in others. Therefore, bronchodilator response measured by Rint should be systematically studied and further assessed in conjunction with clinical outcomes, in order to implement asthma management in children unable to produce reliable

  10. Clinical asthma phenotyping: A trial for bridging gaps in asthma management

    OpenAIRE

    Zedan, Magdy Mohamed; Laimon, Wafaa Nabil; Osman, Amal Mohamed; Zedan, Mohamed Magdy

    2015-01-01

    Asthma is a common disease affecting millions of people worldwide and exerting an enormous strain on health resources in many countries. Evidence is increasing that asthma is unlikely to be a single disease but rather a series of complex, overlapping individual diseases or phenotypes, each defined by its unique interaction between genetic and environmental factors. Asthma phenotypes were initially focused on combinations of clinical characteristics, but they are now evolving to link pathophys...

  11. GLOBAL STRATEGY FOR THE DIAGNOSIS AND MANAGEMENT OF ASTHMA IN CHILDREN 5 YEARS AND YOUNGER

    OpenAIRE

    Pedersen, Soren; Hurd, Suzanne; Lemanske, Robert; Becker, Allan; Zar, Heather; Sly, Peter; Soto-Quiroz, Manuel; Wong, Gary; Bateman, Eric

    2010-01-01

    Abstract Asthma is the most common chronic disease of childhood and the leading cause of childhood morbidity from chronic disease as measured by school absences, emergency department visits, and hospitalizations1. Many scientific advances have improved our understanding of asthma and our ability to manage and control it effectively. However, in children 5 years and younger, the clinical symptoms of asthma are variable and non-specific. Furthermore, neither airflow limitation nor...

  12. Global strategy for the diagnosis and management of asthma in children 5 years and younger.

    Science.gov (United States)

    Pedersen, Soren Erik; Hurd, Suzanne S; Lemanske, Robert F; Becker, Allan; Zar, Heather J; Sly, Peter D; Soto-Quiroz, Manuel; Wong, Gary; Bateman, Eric D

    2011-01-01

    Asthma is the most common chronic disease of childhood and the leading cause of childhood morbidity from chronic disease as measured by school absences, emergency department visits, and hospitalisation. During the past two decades, many scientific advances have improved our understanding of asthma and our ability to manage and control it effectively. However, in children 5 years and younger, the clinical symptoms of asthma are variable and non-specific. Furthermore, neither airflow limitation nor airway inflammation, the main pathologic hallmarks of the condition, can be assessed routinely in this age group. For this reason, to aid in the diagnosis of asthma in young children, a symptoms-only descriptive approach that includes the definition of various wheezing phenotypes has been recommended. In 1993, the Global Initiative for Asthma (GINA) was implemented to develop a network of individuals, organizations, and public health officials to disseminate information about the care of patients with asthma while at the same time assuring a mechanism to incorporate the results of scientific investigations into asthma care. Since then, GINA has developed and regularly revised a Global Strategy for Asthma Management and Prevention. Publications based on the Global Strategy for Asthma Management and Prevention have been translated into many different languages to promote international collaboration and dissemination of information. In this report, Global Strategy for Asthma Management and Prevention in Children 5 Years and Younger, an effort has been made to present the special challenges that must be taken into account in managing asthma in children during the first 5 years of life, including difficulties with diagnosis, the efficacy and safety of drugs and drug delivery systems, and the lack of data on new therapies. Approaches to these issues will vary among populations in the world based on socioeconomic conditions, genetic diversity, cultural beliefs, and differences in

  13. Do United States’ Teachers Know and Adhere to the National Guidelines on Asthma Management in the Classroom? A Systematic Review

    Directory of Open Access Journals (Sweden)

    Yudilyn Jaramillo

    2015-01-01

    Full Text Available Proper asthma management in schools is important in achieving optimum asthma control in children with asthma. The National Heart, Lung, and Blood Institute (NHLBI has developed guidelines on classroom asthma management. We conducted a systematic review to examine teacher knowledge of the NHLBI guidelines on asthma management in the classroom. We searched PubMed and EMBASE using search terms “asthma management,” “teacher(s,” “school teacher,” and “public school.” The inclusion criteria were articles published in English from 1994 to May 2014 that focus on schools in the United States (US. From 535 titles and abstracts, 9 studies met inclusion criteria. All studies reported that school teachers did not know the policies and procedures of asthma management. Teachers relied on school nurses to handle medical emergencies. Some studies identified that lack of full-time school nurses was a barrier to asthma management. Only one study showed directly that classroom teachers were not following the NHLBI guidelines on asthma management. Our literature review revealed that US teachers do not know the NHLBI guidelines on asthma management in the classroom. Future research should focus on interventions targeted toward training classroom teachers on asthma management as per NHLBI guidelines to ultimately improve asthma management in schools.

  14. The role of tiotropium in the management of asthma

    OpenAIRE

    Park, Heung-Woo

    2012-01-01

    Asthma is a chronic respiratory disease characterized by reversible airway obstruction that is secondary to an allergic inflammation and excessive smooth muscle contraction. Cholinergic signals were known to contribute significantly to the pathophysiology of asthma. However, the use of anti-cholinergic agents in asthma has been justified only in acute asthma exacerbations, until tiotropium bromide, a long-acting anti-cholinergic agent was introduced. Recent reports showing a promising role of...

  15. Diagnosis and management of eosinophilic asthma: a US perspective

    OpenAIRE

    Walford HH; Doherty TA

    2014-01-01

    Hannah H Walford,1,2 Taylor A Doherty11Department of Medicine, 2Department of Pediatrics, University of California, La Jolla, CA, USAAbstract: Eosinophilic asthma is now recognized as an important subphenotype of asthma based on the pattern of inflammatory cellular infiltrate in the airway. Eosinophilic asthma can be associated with increased asthma severity, atopy, late-onset disease, and steroid refractoriness. Induced sputum cell count is the gold standard for identifying eosinophilic infl...

  16. Management of asthma in pregnant women by general practitioners: A cross sectional survey

    Directory of Open Access Journals (Sweden)

    Abramson Michael J

    2011-11-01

    Full Text Available Abstract Background Poorly controlled asthma can lead to maternal and fetal complications. Despite the known risks of poorly controlled asthma during pregnancy and the need for stepping up therapy when appropriate, there are concerns that management is suboptimal in primary care. Our objective was to investigate the management of asthma during pregnancy by general practitioners providing shared maternity care. Methods A pre-piloted, anonymous mail survey was sent to all general practitioners (n = 842 involved in shared maternity care at six maternity hospitals in Victoria, Australia. Respondents were asked about their perceived safety of individual asthma medications during pregnancy. Approach to asthma management during pregnancy was further explored using scenarios of pregnant women with stable and deteriorating asthma and poor medication adherence. Results Inhaled corticosteroids (ICS were perceived to be the safest and were the preferred preventive medication in first trimester (74.1%, whilst leukotriene receptor antagonists were the least preferred (2.9%. A quarter (25.8% of respondents would stop or decrease patients' ICS doses during pregnancy, even when their asthma was well controlled by current therapy. In addition, 12.1% of respondents were not sure how to manage deteriorating asthma during pregnancy and opted to refer to another health professional. Almost half the respondents (48.9% reported encountering medication nonadherence during pregnancy. Conclusion A lack of confidence and/or knowledge among general practitioners in managing deteriorating asthma in pregnancy was observed despite a good understanding of the safety of asthma medications during pregnancy, compliance with evidence-based guidelines in the selection of preventive medications, and self reported good asthma knowledge.

  17. [Moderate asthma in adults: diagnosis and management in general medical practice].

    Science.gov (United States)

    Vernejoux, J M; Tunon De Lara, J M; Guizard, A V; Villanueva, P; Taytard, A

    1996-10-01

    Moderate asthma is a frequent disorder in general medicine. In 1990, the British Thoracic Society published their first guidelines on the management of asthma. Three years later, we have studied, using a questionnaire, the diagnosis and therapeutic criteria of moderate asthma used by general physicians, and comparing these to the guideline recommendations. Out of 46 physicians questioned in Bordeaux, 40 (87 per cent) agreed to participate in the study. Thirty two physicians (80 per cent) described as moderate an asthma which was mild according to the guidelines; eight physicians (20 per cent) described a moderate asthma according to the guidelines; twenty five (63 per cent) considered as severe a moderate asthma according to the recommendations, although eleven (28 per cent) considered it as moderate and four (10 per cent) did not give an opinion. In total, four (10 per cent) judged asthma severity according to the guidelines (Group R), twenty one (52 per cent) over-estimated the severity of moderate asthma (Group S), and fifteen (37 per cent) gave an inconsistent assessment (Group 1). Twenty six (65 per cent) prescribed an association of beta-2-agonists and inhaled corticosteroids for moderate asthma. Although most of the questioned physicians gave an appropriate treatment for moderate asthma treatment adapted to the severity of the situation, their therapeutic approach did not seem to be based upon the same criteria than that recommended in the guidelines.

  18. Creation and implementation of SAMPRO™: A school-based asthma management program.

    Science.gov (United States)

    Lemanske, Robert F; Kakumanu, Sujani; Shanovich, Kathleen; Antos, Nicholas; Cloutier, Michelle M; Mazyck, Donna; Phipatanakul, Wanda; Schantz, Shirley; Szefler, Stanley; Vandlik, Renee; Williams, Paul

    2016-09-01

    Clinicians who care for children with asthma have an obligation to coordinate asthma care with the schools. Aside from routine clinical care of asthmatic children, providers must educate the family and child about the need for an asthma treatment plan in school and support the school nurse meeting the needs of the student requiring school-based asthma care. The following article was developed by multiple stakeholders to address this need. It describes the 4 components of the School-based Asthma Management Program (SAMPRO™). SAMPRO™ details elements necessary for the education of children, families, clinicians, and school-based personnel based on a "circle of support" that would enhance multidirectional communication and promote better care for children with asthma within the school setting. PMID:27596707

  19. Study protocol for Women of Color and Asthma Control: A randomized controlled trial of an asthma-management intervention for African American women

    Directory of Open Access Journals (Sweden)

    Janevic Mary R

    2012-01-01

    Full Text Available Abstract Background Among adults in the United States, asthma prevalence is disproportionately high among African American women; this group also experiences the highest levels of asthma-linked mortality and asthma-related health care utilization. Factors linked to biological sex (e.g., hormonal fluctuations, gender roles (e.g., exposure to certain triggers and race (e.g., inadequate access to care all contribute to the excess asthma burden in this group, and also shape the context within which African American women manage their condition. No prior interventions for improving asthma self-management have specifically targeted this vulnerable group of asthma patients. The current study aims to evaluate the efficacy of a culturally- and gender-relevant asthma-management intervention among African American women. Methods/Design A randomized controlled trial will be used to compare a five-session asthma-management intervention with usual care. This intervention is delivered over the telephone by a trained health educator. Intervention content is informed by the principles of self-regulation for disease management, and all program activities and materials are designed to be responsive to the specific needs of African American women. We will recruit 420 female participants who self-identify as African American, and who have seen a clinician for persistent asthma in the last year. Half of these will receive the intervention. The primary outcomes, upon which the target sample size is based, are number of asthma-related emergency department visits and overnight hospitalizations in the last 12 months. We will also assess the effect of the intervention on asthma symptoms and asthma-related quality of life. Data will be collected via telephone survey and medical record review at baseline, and 12 and 24 months from baseline. Discussion We seek to decrease asthma-related health care utilization and improve asthma-related quality of life in African American

  20. Adolescent Asthma Self-Management: Patient and Parent-Caregiver Perspectives on Using Social Media to Improve Care

    Science.gov (United States)

    Panzera, Anthony D.; Schneider, Tali K.; Martinasek, Mary P.; Lindenberger, James H.; Couluris, Marisa; Bryant, Carol A.; McDermott, Robert J.

    2013-01-01

    Background: Self-management of asthma can now leverage new media technologies. To optimize implementation they must employ a consumer-oriented developmental approach. This study explored benefits of and barriers to improved asthma self-management and identified key elements for the development of a digital media tool to enhance asthma control.…

  1. Cost-utility of a disease management program for patients with asthma

    NARCIS (Netherlands)

    Steuten, Lotte; Palmer, Stephen; Vrijhoef, Bert; Merode, van Frits; Spreeuwenberg, Cor; Severens, Hans

    2007-01-01

    Objectives: The long-term cost-utility of a disease management program (DMP) for adults with asthma was assessed compared to usual care. Methods: A DMP for patients with asthma has been developed and implemented in the region of Maastricht (The Netherlands). By integrating care, the program aims to

  2. Process and Outcomes of School Nurse Case Management for Students with Asthma

    Science.gov (United States)

    Engelke, Martha Keehner; Swanson, Melvin; Guttu, Martha

    2014-01-01

    There have been many studies that have examined the impact of school-based asthma programs on students with asthma. However, most studies do not provide adequate elaboration on the components of the program. Therefore, replication of these programs is difficult. This study examines the process of school nurse case management, which includes the…

  3. Towards Excellence in Asthma Management: Final Report of an Eight-Year Program Aimed at Reducing Care Gaps in Asthma Management in Quebec

    OpenAIRE

    Louis-Philippe Boulet; Eileen Dorval; Manon Labrecque; Michel Turgeon; Terrence Montague; Thivierge, Robert L

    2008-01-01

    BACKGROUND AND OBJECTIVES: Asthma care in Canada and around the world persistently falls short of optimal treatment. To optimize care, a systematic approach to identifying such shortfalls or ‘care gaps’, in which all stakeholders of the health care system (including patients) are involved, was proposed.METHODS: Several projects of a multipartner, multidisciplinary disease management program, developed to optimize asthma care in Quebec, was conducted in a period of eight years. First, two popu...

  4. The Prevalence, Management and Burden of Asthma-A Nigerian Study

    Directory of Open Access Journals (Sweden)

    Alexander O. Oni

    2010-03-01

    Full Text Available Inadequate attention given to the management of asthma and ways of improving treatment could be a significant factor for the increase morbidity and mortality from asthma despite major advances in our understanding of the pathophysiology of the disease. There seems to be paucity of data concerning the management pattern and burden of asthma in Africa. This study was undertaken to determine the prevalence, management pattern and the burden of asthma.This study was a cross sectional design involving clinical and lung function assessment. The diagnosis of asthma was made using the clinical features of asthma and lung function parameters (Forced expiratory volume in one second, Peak expiratory flow rate, Reversibility tests. Totally, 120 asthma patients participated in this study. All subjects completed the clinical asthma control questionnaires. All items were rated with the calculation of their mean and percentages. Student t-test was used to calculate the difference between the mean of the lung function tests for subjects and control. The prevalence of asthma among respiratory unit patients was 6.6% and higher in the first three decades of life with female preponderance (F:M=1.5-1.There is a strong family history of asthma(81.7%. Associated allergies include rhinitis (75%, pharyngitis (54%, conjunctivitis (54% and dermatitis (30%. Percentage of asthma patients treated with bronchodilators alone (70%, combined inhaled bronchodilators and steroid (28.3%. Impaired daily activities include sports (84%, Job career (60%, Physical activity (55%, Social activity (54%, Household chores (61%, Disturbed sleep (53%, Daytime symptoms (51%, Hospitalized(50%. Subjects had significant low lung function values when compared with control (P

  5. Nasal polyps in patients with asthma: prevalence, impact, and management challenges.

    Science.gov (United States)

    Langdon, Cristobal; Mullol, Joaquim

    2016-01-01

    Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) often have coexisting asthma under the concept of "United Airway Disease", being the combination of both diseases, which is one of the most challenging phenotypes to treat. Although clinicians have recognized this difficult-to-treat phenotype for many years, it remained poorly characterized. There is increasing epidemiological evidence linking chronic rhinosinusitis and asthma, but a good understanding of the pathophysiology and the combined management is still lacking. Bronchial asthma is more prevalent in patients who suffer chronic rhinosinusitis, while asthmatic patients have a greater prevalence of CRSwNP than patients without asthma. The effect of CRSwNP treatment, whether medical or surgical, in asthma is today less controversial after some studies have shown improvement of asthma after medical and/or surgical treatment of CRSwNP. However, direct comparisons between surgical and medical treatments are limited. Further randomized clinical trials are, however, still needed to better understand the management when both asthma and CRSwNP occur together. This review aims at summarizing the prevalence, impact, and management challenges regarding both asthma and CRSwNP. PMID:27042129

  6. Relationship of asthma management, socioeconomic status, and medication insurance characteristics to exacerbation frequency in children with asthma

    Science.gov (United States)

    Ungar, Wendy J.; Paterson, J. Michael; Gomes, Tara; Bikangaga, Peter; Gold, Milton; To, Teresa; Kozyrskyj, Anita L.

    2016-01-01

    Background Less than 25% of asthmatic children are well controlled. Objective To identify factors associated with asthma exacerbation causing emergency department (ED) visits or hospitalizations related to health status, socioeconomic status (SES), and drug insurance. Methods In this retrospective cohort study, complete data were collected on 490 asthmatic children regarding demographics, SES, drug plan characteristics, health status, health resource use, and symptoms. Interview data were linked to administrative data on asthma ED visits and hospitalizations occurring in the following year. Multiple Poisson regression identified independent variables associated with ED visits or hospitalizations in the full cohort and in a subgroup with prescription drug insurance. Results Younger age, previous emergency visits, nebulizer use, pet ownership, and receipt of asthma education but not an action plan were significantly associated with more frequent exacerbations. In the full cohort, children with high income adequacy had 28% fewer exacerbations than did children with low income adequacy. In the subgroup with drug insurance, girls had 26% fewer exacerbations than did boys, and children with food, drug, or insect allergies had 52% more exacerbations than did children without allergies. Children of families with annual insurance deductibles greater than $90 had 95% fewer exacerbations. Every percentage increase in the proportion of income spent out-of-pocket on asthma medications was associated with a 14% increase in exacerbations. Conclusions Asthma history, disease management factors, and SES were associated with exacerbations requiring urgent care. In families with drug plans, the magnitude of asthma medication cost-sharing as a proportion of household income, rather than income alone, was significantly associated with exacerbations. PMID:21195940

  7. Wildfire Risk Management: Challenges and Opportunities

    Science.gov (United States)

    Thompson, M.; Calkin, D. E.; Hand, M. S.; Kreitler, J.

    2014-12-01

    In this presentation we address federal wildfire risk management largely through the lens of economics, targeting questions related to costs, effectiveness, efficiency, and tradeoffs. Beyond risks to resources and assets such as wildlife habitat, watersheds, and homes, wildfires present financial risk and budgetary instability for federal wildfire management agencies due to highly variable annual suppression costs. Despite its variability, the costs of wildfire management have continued to escalate and account for an ever-growing share of overall agency budgets, compromising abilities to attain other objectives related to forest health, recreation, timber management, etc. Trends associated with a changing climate and human expansion into fire-prone areas could lead to additional suppression costs in the future, only further highlighting the need for an ability to evaluate economic tradeoffs in investments across the wildfire management spectrum. Critically, these economic analyses need to accurately capture the complex spatial and stochastic aspects of wildfire, the inherent uncertainty associated with monetizing environmental impacts of wildfire, the costs and effectiveness of alternative management policies, and linkages between pre-fire investments and active incident management. Investing in hazardous fuels reduction and forest restoration in particular is a major policy lever for pre-fire risk mitigation, and will be a primary focus of our presentation. Evaluating alternative fuel management and suppression policies could provide opportunities for significant efficiency improvements in the development of risk-informed management fire management strategies. Better understanding tradeoffs of fire impacts and costs can help inform policy questions such as how much of the landscape to treat and how to balance investments in treating new areas versus maintaining previous investments. We will summarize current data needs, knowledge gaps, and other factors

  8. Long-acting beta(2)-agonists in management of childhood asthma

    DEFF Research Database (Denmark)

    Bisgaard, H

    2000-01-01

    This review assesses the evidence regarding the use of long-acting beta(2)-agonists in the management of pediatric asthma. Thirty double-blind, randomized, controlled trials on the effects of formoterol and salmeterol on lung function in asthmatic children were identified. Single doses of inhaled......, long-acting beta(2)-agonists provide effective bronchodilatation and bronchoprotection when used as intermittent, single-dose treatment of asthma in children, but not when used as regular treatment. Future studies should examine the positioning of long-acting beta(2)-agonists as an "as needed" rescue...... medication instead of short-acting beta(2)-agonists for pediatric asthma management....

  9. A workshop on asthma management programs and centers in Brazil: reviewing and explaining concepts

    OpenAIRE

    Rafael Stelmach; Alcindo Cerci Neto; Ana Cristina de Carvalho Fernandez Fonseca; Eduardo Vieira Ponte; Gerardo Alves; Ildely Niedia Araujo-Costa; Laura Maria de Lima Belizário Facury Lasmar; Luci Keiko Kuromoto de Castro; Maria Lucia Medeiros Lenz; Paulo Silva; Alberto Cukier; Alexssandra Maia Alves; Aline Silva Lima-Matos; Amanda da Rocha Oliveira Cardoso; Ana Luisa Godoy Fernandes

    2015-01-01

    Objective: To report the results of a workshop regarding asthma management programs and centers (AMPCs) in Brazil, so that they can be used as a tool for the improvement and advancement of current and future AMPCs. Methods: The workshop consisted of five presentations and the corresponding group discussions. The working groups discussed the following themes: implementation of asthma management strategies; human resources needed for AMPCs; financial resources needed for AMPCs; and operational ...

  10. Apps for asthma self-management: a systematic assessment of content and tools

    Directory of Open Access Journals (Sweden)

    Huckvale Kit

    2012-11-01

    Full Text Available Abstract Background Apps have been enthusiastically adopted by the general public. They are increasingly recognized by policy-makers as a potential medium for supporting self-management of long-term conditions. We assessed the degree to which current smartphone and tablet apps for people with asthma offer content and tools of appropriate quality to support asthma self-management. Methods We adapted systematic review methodology to the assessment of apps. We identified English-language asthma apps for all ages through a systematic search of official app stores. We systematically assessed app content using criteria derived from international guidelines and systematic review of strategies for asthma self-management. We covered three domains: comprehensiveness of asthma information, consistency of advice with evidence and compliance with health information best practice principles. Results We identified 103 apps for asthma in English, of which 56 were sources of information about the condition and 47 provided tools for the management of asthma. No apps offered both types of functionality. Only three information apps approached our definition of comprehensiveness of information about asthma. No apps provided advice on lay management of acute asthma that included details of appropriate reliever medication use. In 32 of 72 instances, apps made unequivocal recommendations about strategies for asthma control or prophylaxis that were unsupported by current evidence. Although 90% of apps stated a clear purpose, compliance with other best practice principles for health information was variable. Contact details were located for 55%, funding source for 18% and confidentiality policy for 17%. Conclusions No apps for people with asthma combined reliable, comprehensive information about the condition with supportive tools for self-management. Healthcare professionals considering recommending apps to patients as part of asthma self-management should exercise

  11. Organizational Actively Management for Opportunity Hunting

    Directory of Open Access Journals (Sweden)

    Nasser Fegh-hi FARAHMAND

    2012-03-01

    Full Text Available Organizational Actively Management (OAM is the responsibility of every manager. Because, an approach for OAM is becoming more widely accepted is a community-based development approach. In Opportunity Hunting Approach (OHA, OAM is the responsibility of every manager for his/her actions. OAM is using from top to bottom development model. According to the survey of market and customers, after understand customers’ needs, organization then decide how the quality policy and target will develop, from there the actively management system can be developed. The aim of this study in field of organizational actively management and policy of it can provide the specific process required for setting up and monitoring the actively target. As it also is customer-oriented, it aims to improve customer satisfaction. In addition, the actively target should be set up and implemented within every organization department and at each level, in accordance with actively policy. Furthermore, organization should develop the actively management system, in order to conform to general requirements and actively target.

  12. Asthma in pregnancy - from immunology to clinical management

    Directory of Open Access Journals (Sweden)

    Tamási Lilla

    2010-08-01

    Full Text Available Abstract Asthma is one of the most common chronic medical conditions that may complicate pregnancy. Asthma influences the outcome of pregnancy and, vice versa, pregnancy affects asthma severity, but the underlying immunological mechanisms of this interaction are not fully understood. As a sign of pregnancy-induced immunotolerance, attenuation of allergic responses can be detected in controlled asthmatic pregnant patients; however non controlled asthmatic pregnant women show significant asthma-associated immune reactions that may, beside other factors, influence fetal growth. Generally, although uncontrolled asthma may increase the risk of adverse perinatal outcomes, women with well-controlled and adequately treated disease during pregnancy do not develop maternal or fetal complications.

  13. Asthma & Physical Activity in the School

    Science.gov (United States)

    ... Some students experience asthma symptoms only when they exercise. Asthma varies from student to student and often from ... activities and other regular school activities. Table 1: BENEFITS OF ASTHMA CONTROL With good asthma management, students with asthma ...

  14. Mometasone furoate in the management of asthma: a review

    Directory of Open Access Journals (Sweden)

    Ricardo A Tan

    2008-09-01

    Full Text Available Ricardo A Tan1, Jonathan Corren21California Allergy and Asthma Medical Group, Los Angeles, CA; 2Allergy Research Foundation, Los Angeles, CA, USAAbstract: Inhaled corticosteroids (ICS have proven to be the most effective and essential therapy for the treatment of bronchial asthma. The 2007 National Asthma Education and Prevention Program guidelines recommend ICS as preferred therapy for patients with mild to severe persistent asthma. Mometasone furoate (MF is a relatively new ICS agent with high affinity for the glucocorticoid receptor. It is approved in the US for maintenance treatment of asthma for patients 4 years of age and older. It has been shown to be well tolerated with no significant adverse side effects observed in clinical trials and post-marketing surveillance. The efficacy of mometasone furoate has been established in large, well-designed studies. In patients with persistent asthma previously treated either with short-acting beta-agonists alone or twice-daily maintenance therapy with ICS, once-daily MF has been shown to be superior to placebo in improving lung function, symptom control, and quality of life; and has shown comparable efficacy compared with budesonide, beclomethasone, and fluticasone. Twice-daily dosing with MF has been demonstrated to successfully allow for reduction or elimination of oral corticosteroids in severe asthmatics.Keywords: inhaled steroids, mometasone furoate, once-daily dosing, asthma, stepwise approach

  15. Nasal polyps in patients with asthma: prevalence, impact, and management challenges

    Directory of Open Access Journals (Sweden)

    Langdon C

    2016-03-01

    Full Text Available Cristobal Langdon,1,2 Joaquim Mullol1–3 1Rhinology Unit and Smell Clinic, Otorhinolaryngology Department, Hospital Clínic, 2Clinical and Experimental Respiratory Immunoallergy (IRCE, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS, 3Centre for Biomedical Research in Respiratory Diseases (CIBERES, Barcelona, Catalonia, SpainAbstract: Patients with chronic rhinosinusitis with nasal polyps (CRSwNP often have coexisting asthma under the concept of “United Airway Disease”, being the combination of both diseases, which is one of the most challenging phenotypes to treat. Although clinicians have recognized this difficult-to-treat phenotype for many years, it remained poorly characterized. There is increasing epidemiological evidence linking chronic rhinosinusitis and asthma, but a good understanding of the pathophysiology and the combined management is still lacking. Bronchial asthma is more prevalent in patients who suffer chronic rhinosinusitis, while asthmatic patients have a greater prevalence of CRSwNP than patients without asthma. The effect of CRSwNP treatment, whether medical or surgical, in asthma is today less controversial after some studies have shown improvement of asthma after medical and/or surgical treatment of CRSwNP. However, direct comparisons between surgical and medical treatments are limited. Further randomized clinical trials are, however, still needed to better understand the management when both asthma and CRSwNP occur together. This review aims at summarizing the prevalence, impact, and management challenges regarding both asthma and CRSwNP. Keywords: chronic rhinosinusitis, asthma, united airways, rhinosinusitis, corticosteroids, sinus surgery

  16. New therapies and management strategies in the treatment of asthma: patient-focused developments

    Directory of Open Access Journals (Sweden)

    Joshua Agbetile

    2010-12-01

    Full Text Available Joshua Agbetile, Ruth GreenDepartment of Respiratory Medicine and Thoracic Surgery, Institute for Lung Health, Glenfield Hospital, Leicester, UKAbstract: It is increasingly recognized that large proportions of patients with asthma remain poorly controlled with daily symptoms, limitation in activities, or severe exacerbations despite traditional treatment with inhaled corticosteroids and other agents. This suggests that there is considerable scope for the refinement of traditional guidelines on the use of inhaled therapies in asthma and also a need for the development of novel therapeutic agents, particularly for the treatment of severe asthma. This review aims to discuss a range of emerging treatment approaches in asthma. Firstly, we will set the scene by highlighting the importance of achieving good asthma control in a patient-focused manner and discussing recent work that has furthered our understanding of asthma phenotypes and paved the way for patient-specific treatments. Secondly, we will review new strategies to better use the existing therapies such as inhaled corticosteroids and long-acting β2-agonists that remain the mainstay of treatment for most patients. Finally, we will review the novel therapies that are becoming available, both pharmacological and interventional, and discuss their likely place in the management of this complex disease.Keywords: asthma, treatments, classification, phenotypes, management

  17. Asthma action plan

    OpenAIRE

    Public Health Agency

    2014-01-01

    This action plans allow each child (or parent/carer) to record his or her asthma treatment to help manage their asthma when they are well, when their symptoms get worse and when they are suffering an asthma attack.

  18. Can a self-management programme delivered by a community pharmacist improve asthma control? A randomised trial

    OpenAIRE

    Barbanel, D; Eldridge, S; Griffiths, C

    2003-01-01

    Background: No randomised studies have addressed whether self-management for asthma can be successfully delivered by community pharmacists. Most randomised trials of asthma self-management have recruited participants from secondary care; there is uncertainty regarding its effectiveness in primary care. A randomised controlled study was undertaken to determine whether a community pharmacist could improve asthma control using self-management advice for individuals recruited during attendance at...

  19. The role of the asthma nurse in treatment compliance and self-management following hospital admission.

    Science.gov (United States)

    Morice, A H; Wrench, C

    2001-11-01

    Effective self-management and treatment compliance is important in achieving good symptom control in asthma. The aim of this study was to determine whether asthma nurse intervention during hospital admission could increase knowledge and improve self-management and whether this would influence the number of emergency call-out visits by Genera Practitioners (GPs) and hospital re-admissions. Patients with acute asthma (n=80) were assessed by the asthma nurse within 24 h of admission using a British Thoracic Society (BTS) guideline-based questionnaire. Main outcome measures were: know edge of inhalers, self-management plans, peak flow monitoring, recognition of worsening symptoms and appropriate emergency action, Following randomization, half received nurse intervention during hospitalization. All received a follow-up questionnaire 6 weeks post-discharge and again at 6 months (response rates 86% and 81% respectively). GPs were contacted by postal questionnaire after 4 months. Questionnaire responses indicated an increase in knowledge in the intervention group, along with an ability to identify appropriate action on worsening symptoms. Emergency GP call-outs were more frequent in the control group in the 4 months post-discharge. Hospital re-admission rates were similar in both groups. Asthma nurse intervention appeared to increase knowledge of asthma management, maintained throughout the study period, but had no significant impact on reducing re-admissions to hospital.

  20. Color management: printing processes - opportunities and limitations

    Science.gov (United States)

    Ingram, Samuel T.

    2002-06-01

    Digital tools have impacted traditional methods employed to reproduce color images during the past decade. The shift from a purely photomechanical process in color reproduction to colorimetric reproduction offers tremendous opportunity in the graphic arts industry. But good things do not necessarily come to all in the same package. Printing processes possess different reproduction attributes: tone reproduction, gray balance and color correction requirements are as different as the ingredient sets selected for color reproduction. This paper will provide insight toward understanding advantages and limitations offered by the new digital technologies in printing, publishing and packaging. For the past five years the Clemson University Graphic Communications Department has conducted numerous color projects using the new digital colorimetric tools during the previous decade. Several approaches have been used including experimental research and typical production workflows. The use of colorimetric data in color reproduction has given an opportunity to realize real gains in color use, predictability and consistency. Meeting an image's separation and reproduction requirements for a specified printing process can involve disruption of the anticipated workflow. Understanding the printing process requirements and the fit within the specifications of a colorimetric workflow are critical to the successful adoption of a color managed workflow. The paper will also provide an insight into the issues and challenges experienced with a color managed workflow. The printing processes used include offset litho, narrow and wide-web flexography (paper, liner board, corrugated and film), screen printing (paper board and polycarbonates), and digital imaging with toner, ink and inkjet systems. A proposal for technology integration will be the focus of the presentation drawn from documented experiences in over 300 applications of color management tools. Discussion will include the structure of

  1. Development of an Asthma Management System in a Pediatric Emergency Department

    OpenAIRE

    Dexheimer, Judith W; Arnold, Donald H.; Abramo, Thomas J; Aronsky, Dominik

    2009-01-01

    Asthma is the leading chronic childhood disease with exacerbations resulting in urgent and emergency care visits. Guidelines adherence improves patient care but is suboptimal. A computerized guideline system can help improve compliance through automatic initiation and reminders to increase adherence. We designed a computerized management system for asthma care in the pediatric emergency department (ED). The system will be evaluated in two phases. The first phase evaluates a computerized diagn...

  2. Using scenarios to test the appropriateness of pharmacist prescribing in asthma management

    OpenAIRE

    Hanna T; Bajorek B; LeMay K; Armour CL

    2014-01-01

    Objective: To explore the potential for community pharmacist prescribing in terms of usefulness, pharmacists’ confidence, and appropriateness, in the context of asthma management. Methods: Twenty community pharmacists were recruited using convenience sampling from a group of trained practitioners who had already delivered asthma services. These pharmacists were asked to complete a scenario-based questionnaire (9 scenarios) modelled on information from real patients. Pharmacist interventio...

  3. The impact of allergic rhinitis on the management of asthma in a working population

    OpenAIRE

    Provost, Dorothée; Iwatsubo, Yuriko; Riviere, Stéphanie; Mevel, Maëlaïg; Didier, Alain; Brochard, Patrick; Imbernon, Ellen; Raherison, Chantal

    2015-01-01

    Background Currently, little data is available about the management of asthma in the working population. The aim of this study was to describe asthma control and severity among workers according to current or previous allergic rhinitis comorbidity. Methods A network of occupational physicians participated in this pilot study on a voluntary basis. They included a random sample of salaried workers during their systematic occupational medical check-up. All subjects completed a self-administered ...

  4. Recent advances in chronotherapy for the management of asthma

    Directory of Open Access Journals (Sweden)

    Durrington HJ

    2014-11-01

    Full Text Available Hannah J Durrington,1 Stuart N Farrow,2,3 David W Ray2 1Institute of Inflammation and Repair, 2Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK; 3Respiratory Therapy Area, GlaxoSmithKline, Stevenage, UK Abstract: Asthma is a common inflammatory disease of the airways, with a pronounced circadian variation in symptoms. A number of existing asthma treatments are “chronotherapies” designed to be delivered to coincide with the “morning dip” in lung function and corresponding worsening of symptoms. In the past decade, our knowledge of how circadian rhythms are regulated has increased immensely, and increasing evidence that the molecular clock plays a significant role in the immune system makes asthma an intriguing disease to study. The current trend toward once-daily dosing of asthma therapies reduces the need for careful timing of doses; however, patients are exposed to therapeutic levels of the drug and potential side effects for the entire day. Consequently, improved therapeutic benefit in asthma may be gained by understanding the molecular pathways that drive the predictable, diurnal worsening of symptoms. Furthermore, timing the delivery of therapy to coincide with pathway sensitivity may deliver maximum benefit. Defining the role of the molecular clock in these pathways could therefore lead to novel therapies and improved asthma control. Keywords: anticholinergic, beta agonist, corticosteroids, FEV1, PEFR, theophylline

  5. A workshop on asthma management programs and centers in Brazil: reviewing and explaining concepts

    Directory of Open Access Journals (Sweden)

    Rafael Stelmach

    2015-02-01

    Full Text Available Objective: To report the results of a workshop regarding asthma management programs and centers (AMPCs in Brazil, so that they can be used as a tool for the improvement and advancement of current and future AMPCs. Methods: The workshop consisted of five presentations and the corresponding group discussions. The working groups discussed the following themes: implementation of asthma management strategies; human resources needed for AMPCs; financial resources needed for AMPCs; and operational maintenance of AMPCs. Results: The workshop involved 39 participants, from all regions of the country, representing associations of asthma patients (n = 3, universities (n = 7, and AMPCs (n = 29. We found a direct relationship between a lack of planning and the failure of AMPCs. Based on the experiences reported during the workshop, the common assumptions about AMPCs in Brazil were the importance of raising awareness of managers; greater community participation; interdependence between primary care and specialized care; awareness of regionalization; and use of medications available in the public health system. Conclusions: Brazil already has a core of experience in the area of asthma management programs. The implementation of strategies for the management of chronic respiratory disease and their incorporation into health care system protocols would seem to be a natural progression. However, there is minimal experience in this area. Joint efforts by individuals with expertise in AMPCs could promote the implementation of asthma management strategies, thus speeding the creation of treatment networks, which might have a multiplier effect, precluding the need for isolated centers to start from zero.

  6. A workshop on asthma management programs and centers in Brazil: reviewing and explaining concepts*

    Science.gov (United States)

    Stelmach, Rafael; Neto, Alcindo Cerci; Fonseca, Ana Cristina de Carvalho Fernandez; Ponte, Eduardo Vieira; Alves, Gerardo; Araujo-Costa, Ildely Niedia; Lasmar, Laura Maria de Lima Belizário Facury; de Castro, Luci Keiko Kuromoto; Lenz, Maria Lucia Medeiros; Silva, Paulo; Cukier, Alberto; Alves, Alexssandra Maia; Lima-Matos, Aline Silva; Cardoso, Amanda da Rocha Oliveira; Fernandes, Ana Luisa Godoy; de São-José, Bruno Piassi; Riedi, Carlos Antônio; Schor, Deborah; Peixoto, Décio Medeiros; Brandenburg, Diego Djones; Camillo, Elineide Gomes dos Santos; Serpa, Faradiba Sarquis; Brandão, Heli Vieira; Lima, João Antonio Bonfadini; Pio, Jorge Eduardo; Fiterman, Jussara; Anderson, Maria de Fátima; Cardoso, Maria do Socorro de Lucena; Rodrigues, Marcelo Tadday; Pereira, Marilyn Nilda Esther Urrutia; Antila, Marti; Martins, Sonia Maria; Guimarães, Vanessa Gonzaga Tavares; Mello, Yara Arruda Marques; de Andrade, Wenderson Clay Correia; Salibe-Filho, William; Caldeira, Zelina Maria da Rocha; da Cruz-Filho, Álvaro Augusto Souza; Camargos, Paulo

    2015-01-01

    Objective: To report the results of a workshop regarding asthma management programs and centers (AMPCs) in Brazil, so that they can be used as a tool for the improvement and advancement of current and future AMPCs. Methods: The workshop consisted of five presentations and the corresponding group discussions. The working groups discussed the following themes: implementation of asthma management strategies; human resources needed for AMPCs; financial resources needed for AMPCs; and operational maintenance of AMPCs. Results: The workshop involved 39 participants, from all regions of the country, representing associations of asthma patients (n = 3), universities (n = 7), and AMPCs (n = 29). We found a direct relationship between a lack of planning and the failure of AMPCs. Based on the experiences reported during the workshop, the common assumptions about AMPCs in Brazil were the importance of raising awareness of managers; greater community participation; interdependence between primary care and specialized care; awareness of regionalization; and use of medications available in the public health system. Conclusions: Brazil already has a core of experience in the area of asthma management programs. The implementation of strategies for the management of chronic respiratory disease and their incorporation into health care system protocols would seem to be a natural progression. However, there is minimal experience in this area. Joint efforts by individuals with expertise in AMPCs could promote the implementation of asthma management strategies, thus speeding the creation of treatment networks, which might have a multiplier effect, precluding the need for isolated centers to start from zero. PMID:25750669

  7. Canadian Thoracic Society 2012 Guideline Update: Diagnosis and Management of Asthma in Preschoolers, Children and Adults: Executive Summary

    Directory of Open Access Journals (Sweden)

    M Diane Lougheed

    2012-01-01

    Full Text Available BACKGROUND: In 2010, the Canadian Thoracic Society (CTS published a Consensus Summary for the diagnosis and management of asthma in children six years of age and older, and adults, including an updated Asthma Management Continuum. The CTS Asthma Clinical Assembly subsequently began a formal clinical practice guideline update process, focusing, in this first iteration, on topics of controversy and/or gaps in the previous guidelines.

  8. Knowledge of and reported asthma management among South Australian general practitioners.

    NARCIS (Netherlands)

    Coates, J.R.; Steven, I.D.; Beilby, J.; Coffey, G.; Litt, J.C.B.; Wagner, C.

    1994-01-01

    AIM. This study, carried out in 1989, set out to assess general practitioners' knowledge of asthma management and their reported management practices. METHOD. Of 153 randomly selected South Australian general practitioners 127 (83%) completed a questionnaire designed to explore issues relating to th

  9. Windows of Opportunity for Groundwater Management

    Science.gov (United States)

    Foster, T.; Brozovic, N.; Butler, A. P.

    2015-12-01

    To date, there has been little attention focused on how the value and effectiveness of groundwater management is influenced by the timing of regulatory intervention relative to aquifer depletion. To address this question, we develop an integrated framework that couples an agro-economic model of farmers' field-level irrigation decision-making with a model of a groundwater abstraction borehole. Unlike existing models that only consider the impact of aquifer depletion on groundwater extraction costs, our model also captures the dynamic changes in well productivity and how these in turn affect crop yields and farmer incomes. We use our model to analyze how the value of imposing groundwater quotas is affected by the prior level of depletion before regulations are introduced. Our results demonstrate that there is a range of aquifer conditions within which regulating groundwater use will deliver long-term economic benefits for farmers. In this range, restricting abstraction rates slows the rate of change in well yields and, as a result, increases agricultural production over the simulated planning horizon. Contrastingly, when current saturated thickness is outside this range, regulating groundwater use will provide negligible social benefits and will impose large negative impacts on farm-level profits. We suggest that there are 'windows of opportunity' for managing aquifer depletion that are a function of local hydrology as well as economic characteristics. Regulation that is too early will harm the rural economy needlessly, while regulation that is too late will be unable to prevent aquifer exhaustion. The insights from our model can be a valuable tool to help inform policy decisions about when, and at what level, regulations should be implemented in order to maximize the benefits obtained from limited groundwater resources.

  10. Management of chronic rhinosinusitis with nasal polyps and coexisting asthma

    DEFF Research Database (Denmark)

    Rix, Iben; Håkansson, Kåre; Larsen, Christian Grønhøj;

    2015-01-01

    of the evidence for each outcome was graded on the basis of study quality and consistency in findings. RESULTS: We included seven trials in which the effect of montelukast, omalizumab, erythromycin, and functional endoscopic sinus surgery (FESS) were studied in 317 adults with CRSwNP and asthma. All...

  11. Nuclear knowledge management - challenges and opportunities

    International Nuclear Information System (INIS)

    how, and know why. At the know what level, there is sufficient knowledge of nuclear technology to know what needs to be done. This level is the minimum required for senior managers who make decisions and allocate resources. At the know how level, experts have the technical depth to apply their knowledge to nuclear systems and designs. At the know why level, experts have the fundamental understanding of basic phenomena required to generate new knowledge. Each of the three levels of knowledge is required and each has its own set of challenges to maintain. An additional set of challenges involves the infrastructure required for nuclear knowledge development and maintenance. This infrastructure has always been extensive and includes laboratories capable of handling a variety of nuclear materials, research reactors, hot cells, demonstration facilities, and all the supporting activities such as nuclear operations, health physics, active shops, and licensing. In recent years, the cost of this infrastructure has risen due to such drivers as improved waste management and operations practices, increased security, and evolving regulatory requirements. These trends mean that the only economic means to maintain the infrastructure is through large, centralized facilities that are open to, and serve, all the stakeholders. All the characteristics discussed above must be taken into consideration for a robust nuclear knowledge management system. Indeed, it is the responsibility of decision-makers to ensure that these characteristics are in place or accessible for the deployment of major nuclear facilities. This presentation provides an overview of these characteristics, and the challenges and opportunities associated with them. (author)

  12. The Effects of Combining Web-Based eHealth With Telephone Nurse Case Management for Pediatric Asthma Control: A Randomized Controlled Trial

    OpenAIRE

    Gustafson, David; Wise, Meg; Bhattacharya, Abhik; Pulvermacher, Alice; Shanovich, Kathleen; Phillips, Brenda; Lehman, Erik; Chinchilli, Vernon; Hawkins, Robert; Kim, Jee-Seon

    2012-01-01

    Background Asthma is the most common pediatric illness in the United States, burdening low-income and minority families disproportionately and contributing to high health care costs. Clinic-based asthma education and telephone case management have had mixed results on asthma control, as have eHealth programs and online games. Objectives To test the effects of (1) CHESS+CM, a system for parents and children ages 4–12 years with poorly controlled asthma, on asthma control and medication adheren...

  13. Opportunizing: A classic grounded theory study on business and management

    Directory of Open Access Journals (Sweden)

    Ólavur Christiansen

    2006-11-01

    Full Text Available Opportunizing emerged as the core variable of this classic GT study on business and management. Opportunizing is the recurrent main concern that businesses have to continually resolve, and it explains how companies recurrently create, identify, seize or exploit situations to maintain their growth or survival. Opportunizing is the recurrent creation and re-creation of opportunities in business. Opportunizing is basically what business managers do and do all the time. The problematic nature of opportunizing is resolved by a core social process ofopportunizing and its attached sub-processes that account for change over time and for the variations of the problematic nature of its resolution.Opportunizing has five main facets. These are conditional befriending (confidence building & modifying behavior,prospecting (e.g. information gaining, weighing up (information appraisal & decision-making, moment capturing (quick intervention for seizing strategic opportunities, andconfiguration matching (adjusting the business organization to abet the other activities of opportunizing.On a more abstract level, opportunizing has three more organizational facets: the physically boundary-less, the valuehierarchical, and the physically bounded. The first of these called perpetual opportunizing. This emerges from the conjunction of conditional befriending and prospecting. The second facet is called triggering opportunizing. It arises from the coming together of weighing up and moment capturing. The final facet is called spasmodic opportunizing. This happens when moment capturing and configuration matching unite.

  14. Advances in the diagnosis and management of asthma in older adults.

    LENUS (Irish Health Repository)

    Al-Alawi, Mazen

    2013-12-28

    Global estimates on ageing predict an increased burden of asthma in the older population. Consequently, its recognition, diagnosis and management in clinical practice require optimization. This review aims to provide an update for clinicians highlighting advances in the understanding of the ageing process and immunosenescence together with their applicability to asthma from a diagnostic and therapeutic perspective. Ageing impacts airway responses, immune function and influences efficacy of emerging phenotype-specific therapies when applied to the elderly patient. Differentiating eosinophilic and neutrophilic disease accounts for atopic illness and distinguishes long-standing from late-onset asthma. Therapeutic challenges in drug delivery, treatment adherence and side effect profiles persist in the older patient while novel recording devices developed to aid detection of an adequate inhalation evaluates treatment effectiveness and compliance more accurately than previously attainable. Anti-cytokine therapies improve control of brittle asthma while bronchial thermoplasty is an option in refractory cases. Multi-dimensional intervention strategies prove best in the management of asthma in the older adult which remains a condition that is not rare but rarely diagnosed in this patient population.

  15. Inhaled medication for asthma management: evaluation of how asthma patients, medical students, and doctors use the different devices

    Directory of Open Access Journals (Sweden)

    Muniz Janaína Barbosa

    2003-01-01

    Full Text Available Asthma results from a combination of three essential features: airflow obstruction, hyperresponsiveness of airways to endogenous or exogenous stimuli and inflammation. Inadequacy of the techniques to use different inhalation devices is one of the causes of therapeutic failure. The main purpose of this study was to evaluate how 20 medical students, 36 resident physicians of Internal Medicine/Pediatrics, and 40 asthma patients used three devices for inhalation therapy containing placebo. All patients were followed at the Pulmonary Outpatient Service of Botucatu Medical School and had been using inhaled medication for at least six months. The following devices were evaluated: metered dose inhalers (MDI, dry powder inhalers (DPI, and MDI attached to a spacer device. A single observer applied a protocol containing the main steps necessary to obtain a good inhaler technique to follow and grade the use of different devices. Health care professionals tested all three devices and patients tested only the device being used on their management. MDI was the device best known by doctors and patients. MDI use was associated with errors related to the coordination between inspiration and device activation. Failure to exhale completely before inhalation of the powder was the most frequent error observed with DPI use. In summary, patients did not receive precise instruction on how to use inhaled medication and health care professionals were not well prepared to adequately teach their patients.

  16. Use of a management plan for treating asthma in an emergency department.

    OpenAIRE

    Town, I; Kwong, T; Holst, P.; Beasley, R

    1990-01-01

    A standardised management protocol has been developed for the assessment and treatment of adults with acute asthma attending an emergency department. The management protocol consists of an assessment sheet for recording essential features of the history and examination findings and a flow diagram with guidelines for initial management that were based on spirometric recordings. The protocol was introduced at Wellington Hospital in 1986. The effect of this intervention was assessed by analysing...

  17. Helping African American Children Self-Manage Asthma: The Importance of Self-Efficacy

    Science.gov (United States)

    Kaul, Teri

    2011-01-01

    Background: Asthma is the leading cause of chronic illness among children in the United States, with a disproportionately higher incidence among minority children. In an attempt to increase understanding of the factors that may influence self-management of chronic disease, the study examined the relationship between self-efficacy belief and asthma…

  18. The Effects of Self-Management Education for School-Age Children on Asthma Morbidity: A Systematic Review

    Science.gov (United States)

    Ahmad, Emily; Grimes, Deanna E.

    2011-01-01

    The effects of asthma self-management education for school-age children on number of school days missed, emergency department visits and hospital admissions were evaluated through a systematic review of the published research. A total of 9 studies on asthma education programs that were conducted in schools by school nurses and health educators and…

  19. Know How to Use Your Asthma Inhaler

    Medline Plus

    Full Text Available ... Outdoors Management Asthma Action Plan Flu Shots Inhalers Data, Statistics, and Surveillance Most Recent Asthma Data AsthmaStats Asthma-related Missed School Days among Children ...

  20. Know How to Use Your Asthma Inhaler

    Medline Plus

    Full Text Available ... J K L M N O P Q R S T U V W X Y Z # Start ... Management Asthma Action Plan Flu Shots Inhalers Data, Statistics, and Surveillance Most Recent Asthma Data AsthmaStats Asthma- ...

  1. Opportunities for inhaler device selection in elderly patients with asthma or COPD

    Directory of Open Access Journals (Sweden)

    Barrons R

    2015-12-01

    Full Text Available Robert Barrons,1 James Wheeler,2 J Andrew Woods1 1Wingate University School of Pharmacy, Wingate, NC, USA; 2University of Tennessee Health Science Center, Nashville, TN, USA Abstract: An anticipated surge in the elderly population will be accompanied by a rise in aging patients with asthma or COPD. Clinician selection of inhalers needs to address the unique challenges to elderly patients. These challenges to the use of inhalers include diminished physical and cognitive abilities, as well as cost reimbursement issues associated with polypharmacy and the Medicare gap. Clinicians should consider patient preferences for an inhaler device that provides ease of administration, and addresses conveniences such as portability, visual, and auditory indicators of dosing completion. The addition of spacer devices resolves hand-breath coordination difficulty with pressurized metered dose inhalers, but reduces overall inhaler convenience. Soft mist inhalers (Respimat® improve ease of administration, but use may be limited by cost and formulary availability. Multiple dose dry powder inhalers provide convenience and simplified use by requiring only one to two steps prior to administration, but concerns of peak inspiratory flow requirements remain among patients with advanced age and severity of COPD. If unaddressed, these challenges to inhaler selection contribute to inappropriate use of inhalers in 41% to 69% of patients, accompanied by at least 51% non-adherence to treatment. Clinicians must first avail themselves of reputable educational resources regarding new inhaler developments and administration, for competent patient instruction. Patient education should include a checklist of inhaler technique, with physical demonstration of each device by the patient and provider. Device demonstration significantly improves inhaler technique and identifies the need for nebulization therapy. Clinician and patient knowledge of available inhalers and their

  2. Managing Environmental Risk and Investment Opportunities to Maximize Shareholder Wealth

    OpenAIRE

    Christopher A. Manning

    1992-01-01

    This article discusses the opinions of environmental experts, corporate strategy, policies, and analytical tools for companies to manage environmental risk and investment opportunities to maximize shareholder wealth. Policies and procedures helpful for evaluating (1) "cost reducing environmentally beneficial investment opportunities" and (2) "environmental contamination clean up options" are discussed and illustrated in detail. As the application of capital budgeting procedures is often the a...

  3. Technical career opportunities in high-level radioactive waste management

    International Nuclear Information System (INIS)

    Technical career opportunities in high-level radioactive waste management are briefly described in the areas of: Hydrology; geology; biological sciences; mathematics; engineering; heavy equipment operation; and skilled labor and crafts

  4. Diversity Management- A Concept Beyond Equal Opportunities And Discrimination.

    OpenAIRE

    Harrell, Lydia

    2016-01-01

    In this Era of Globalization, where every organisation is working towards having an international competitive advantage, the importance of managing diversity which implies the need to be proactive in managing the needs of a diverse workforce under equal opportunities based on gender, age, race, disability, sexual orientation, religious belief etc  and also beyond equal opportunities and discrimination should be realised. In this study, discrimination at work will be discussed along with the l...

  5. Neutrophilic and Pauci-immune Phenotypes in Severe Asthma.

    Science.gov (United States)

    Panettieri, Reynold A

    2016-08-01

    Although 2 T-helper type 2 inflammation evokes airway hyperresponsiveness and narrowing, neutrophilic or pauci-immune asthma accounts for significant asthma morbidity. Viruses, toxicants, environmental tobacco smoke exposure, and bacterial infections induce asthma exacerbations mediated by neutrophilic inflammation or by structural cell (pauci-immune) mechanisms. Therapeutic challenges exist in the management of neutrophilic and pauci-immune phenotypes because both syndromes manifest steroid insensitivity. The recognition that neutrophil subsets exist and their functions are unique poses exciting opportunities to develop precise therapies. The conventional thought to target neutrophil activation or migration globally may explain why current drug development in neutrophilic asthma remains challenging. PMID:27401627

  6. Managing opportunities in the global knowledge society

    DEFF Research Database (Denmark)

    Nielsen, Sven Hvid

    2007-01-01

    It is commonplace these days to say that knowledge is the most critical asset to be managed. Yet not many people - particularly not practitioners - invest very much time in learning about what knowledge really is and how different knowledge management (KM) is from information management (IM....../practice, disciplinarily/interdisciplinary and by strengthening the link between research, education and practice. Innovation as suggested is creation of a new product-market-technology-organisation-combination (PMTO-combination) consisting of three key elements: 1) Innovation is a process and should be managed as such, 2...

  7. Using scenarios to test the appropriateness of pharmacist prescribing in asthma management

    Directory of Open Access Journals (Sweden)

    Hanna T

    2014-03-01

    Full Text Available Objective: To explore the potential for community pharmacist prescribing in terms of usefulness, pharmacists’ confidence, and appropriateness, in the context of asthma management. Methods: Twenty community pharmacists were recruited using convenience sampling from a group of trained practitioners who had already delivered asthma services. These pharmacists were asked to complete a scenario-based questionnaire (9 scenarios modelled on information from real patients. Pharmacist interventions were independently reviewed and rated on their appropriateness according to the Respiratory Therapeutic Guidelines (TG by three expert researchers. Results: In seven of nine scenarios (78%, the most common prescribing intervention made by pharmacists agreed with TG recommendations. Although the prescribing intervention was appropriate in the majority of cases, the execution of such interventions was not in line with guidelines (i.e. dosage or frequency in the majority of scenarios. Due to this, only 47% (76/162 of the interventions overall were considered appropriate. However, pharmacists were deemed to be often following common clinical practice for asthma prescribing. Therefore 81% (132/162 of prescribing interventions were consistent with clinical practice, which is often not guideline driven, indicating a need for specific training in prescribing according to guidelines. Pharmacists reported that they were confident in making prescribing interventions and that this would be very useful in their management of the patients in the scenarios. Conclusion: Community pharmacists may be able to prescribe asthma medications appropriately to help achieve good outcomes for their patients. However, further training in the guidelines for prescribing are required if pharmacists are to support asthma management in this way.

  8. Challenges and opportunities in multichannel customer management

    NARCIS (Netherlands)

    Neslin, Scott A.; Grewal, Dhruv; Leghorn, Robert; Shankar, Venkatesh; Teerling, Marije L.; Thomas, Jacquelyn S.; Verhoef, Peter C.

    2006-01-01

    Multichannel customer management is the design, deployment, coordination, and evaluation of channels through which firms and customers interact, with the goal of enhancing customer value through effective customer acquisition, retention, and development. The authors identify five major challenges pr

  9. Mobile phone-based asthma self-management aid for adolescents (mASMAA): a feasibility study

    OpenAIRE

    Rhee H; Allen J.; Mammen J; Swift M

    2014-01-01

    Hyekyun Rhee,1 James Allen,2 Jennifer Mammen,1 Mary Swift21School of Nursing, 2Department of Computer Science, University of Rochester, Rochester, NY, USAPurpose: Adolescents report high asthma-related morbidity that can be prevented by adequate self-management of the disease. Therefore, there is a need for a developmentally appropriate strategy to promote effective asthma self-management. Mobile phone-based technology is portable, commonly accessible, and well received by adolescents. The pu...

  10. Implementation strategies of internet-based asthma self-management support in usual care. Study protocol for the IMPASSE cluster randomized trial

    NARCIS (Netherlands)

    Gaalen, J.L. van; Bakker, M.J.; Bodegom-Vos, L. van; Snoeck-Stroband, J.B.; Assendelft, W.J.J.; Kaptein, A.A.; Meer, V. van der; Taube, C.; Thoonen, B.P.A.; Sont, J.K.; for the, I.s.g.

    2012-01-01

    ABSTRACT: BACKGROUND: Internet-based self-management (IBSM) support cost-effectively improves asthma control, asthma related quality of life, number of symptom-free days, and lung function in patients with mild to moderate persistent asthma. The current challenge is to implement IBSM in clinical pra

  11. The management of asthma in the phenotype and biomarker era: The proposal of a new diagnostic-therapeutic model.

    Science.gov (United States)

    Blasi, Francesco; Bettoncelli, Germano; Canonica, Giorgio Walter; Centanni, Stefano; Crimi, Nunzio; DiMaria, Giuseppe; Gasparini, Stefano; Gentili, Gilberto; Girbino, Giuseppe; Mereu, Carlo; Minghetti, Paola; Nardini, Stefano; Paggiaro, Pierluigi; Papi, Alberto; Pistolesi, Massimo; Rossi, Andrea

    2016-09-01

    Treatment goals in asthma patients are the achievement of a good control of symptoms and the reduction of the risk of exacerbation. However, a "one-size-fits-all" therapeutic strategy is no longer appropriate to effectively pursue these goals, due to the heterogeneity of asthma. To make the treatment scenario even more complex, asthma patients often present comorbidities that may alter response to therapy. In addition, adherence to asthma treatment is poor. Given this complex and heterogeneous picture, the management of asthma is highly challenging. A clear diagnostic-therapeutic model of patients' care and the definition of the specific responsibilities of different healthcare providers appear necessary to improve clinical outcomes and better allocate healthcare resources. We present here a proposal for this model.

  12. The management of asthma in the phenotype and biomarker era: The proposal of a new diagnostic-therapeutic model.

    Science.gov (United States)

    Blasi, Francesco; Bettoncelli, Germano; Canonica, Giorgio Walter; Centanni, Stefano; Crimi, Nunzio; DiMaria, Giuseppe; Gasparini, Stefano; Gentili, Gilberto; Girbino, Giuseppe; Mereu, Carlo; Minghetti, Paola; Nardini, Stefano; Paggiaro, Pierluigi; Papi, Alberto; Pistolesi, Massimo; Rossi, Andrea

    2016-09-01

    Treatment goals in asthma patients are the achievement of a good control of symptoms and the reduction of the risk of exacerbation. However, a "one-size-fits-all" therapeutic strategy is no longer appropriate to effectively pursue these goals, due to the heterogeneity of asthma. To make the treatment scenario even more complex, asthma patients often present comorbidities that may alter response to therapy. In addition, adherence to asthma treatment is poor. Given this complex and heterogeneous picture, the management of asthma is highly challenging. A clear diagnostic-therapeutic model of patients' care and the definition of the specific responsibilities of different healthcare providers appear necessary to improve clinical outcomes and better allocate healthcare resources. We present here a proposal for this model. PMID:27050723

  13. Risk and opportunities management for programmes and projects: A synopsis

    OpenAIRE

    Kutsch, Elmar; Murray-Webster, Ruth; Maylor, Harvey

    2008-01-01

    The purpose of this document is to provide the reader with a synopsis of current thinking in the area of risk and opportunities management in programmes and projects. It forms part of a package delivered to EDS and the thinking described is reflected in the changes recommended to the principles of risk management used in the organisation.

  14. Diagnosis and management of asthma in preschoolers: A Canadian Thoracic Society and Canadian Paediatric Society position paper.

    Science.gov (United States)

    Ducharme, Francine M; Dell, Sharon D; Radhakrishnan, Dhenduka; Grad, Roland M; Watson, Wade T A; Yang, Connie L; Zelman, Mitchell

    2015-01-01

    Asthma often starts before six years of age. However, there remains uncertainty as to when and how a preschool-age child with symptoms suggestive of asthma can be diagnosed with this condition. This delays treatment and contributes to both short- and long-term morbidity. Members of the Canadian Thoracic Society Asthma Clinical Assembly partnered with the Canadian Paediatric Society to develop a joint working group with the mandate to develop a position paper on the diagnosis and management of asthma in preschoolers. In the absence of lung function tests, the diagnosis of asthma should be considered in children one to five years of age with frequent (≥ 8 days/month) asthma-like symptoms or recurrent (≥ 2) exacerbations (episodes with asthma-like signs). The diagnosis requires the objective document of signs or convincing parent-reported symptoms of airflow obstruction (improvement in these signs or symptoms with asthma therapy), and no clinical suspicion of an alternative diagnosis. The characteristic feature of airflow obstruction is wheezing, commonly accompanied by difficulty breathing and cough. Reversibility with asthma medications is defined as direct observation of improvement with short-acting ß2-agonists (SABA) (with or without oral corticosteroids) by a trained health care practitioner during an acute exacerbation (preferred method). However, in children with no wheezing (or other signs of airflow obstruction) on presentation, reversibility may be determined by convincing parental report of a symptomatic response to a three-month therapeutic trial of a medium dose of inhaled corticosteroids with as-needed SABA (alternative method), or as-needed SABA alone (weaker alternative method). The authors provide key messages regarding in whom to consider the diagnosis, terms to be abandoned, when to refer to an asthma specialist and the initial management strategy. Finally, dissemination plans and priority areas for research are identified.

  15. Opportunities to enhance management of karstic aquifers

    Science.gov (United States)

    Parizek, Richard R.

    2007-01-01

    Methods exist to obtain “new sources of water.” Examples include: (1) capturing and enhancing stormwater recharge and retention within diffuse-flow portions of karst and other aquifers; (2) recycling and reuse of waste water; (3) reducing evapotranspiration and rejected recharge; and (4) ameliorating atmospheric acid deposition through use of alkaline groundwater. These little used management methods have immense potential to sustain future water demands. Full utilization of “new” and traditional water resources requires an understanding of the hydrogeologic framework of karstic aquifers. Reliable conceptual, numerical flow and transport models are needed to help evaluate, select, and design viable water management options. Three such simulation examples are provided together with a discussion of Penn State’s Wastewater reuse project where recharge approaches 3.785 × 109l/year

  16. Supply chain management: An opportunity for metaheuristics

    OpenAIRE

    Ramalhinho-Louren??o, Helena

    2001-01-01

    In today?s highly competitive and global marketplace the pressure on organizations to find new ways to create and deliver value to customers grows ever stronger. In the last two decades, logistics and supply chain has moved to the center stage. There has been a growing recognition that it is through an effective management of the logistics function and the supply chain that the goal of cost reduction and service enhancement can be achieved. The key to success in Supply Chain...

  17. Benefit-risk assessment of antileukotrienes in the management of asthma.

    Science.gov (United States)

    García-Marcos, Luis; Schuster, Antje; Pérez-Yarza, Eduardo G

    2003-01-01

    Antileukotrienes are a relatively new class of anti-asthma drugs that either block leukotriene synthesis (5-lipoxygenase inhibitors) like zileuton, or antagonise the most relevant of their receptors (the cysteinyl leukotriene 1 receptor [CysLT1]) like montelukast, zafirlukast or pranlukast. Hence, their major effect is an anti-inflammatory one. With the exception of pranlukast, the other antileukotrienes have been studied and marketed in the US and Europe for long enough to establish that they are useful drugs in the management of asthma. Their effects, significantly better than placebo, seem more pronounced in subjective measurements (i.e. symptoms scores or quality-of-life tests) than in objective parameters (i.e. forced expiratory volume in 1 second or peak expiratory flow rate). Also, there is some evidence that these drugs work better in some subsets of patients with certain genetic polymorphisms - probably related to their leukotriene metabolism - or patients with certain asthma characteristics. There are a small number of comparative studies only, and with regard to long-term asthma control differences between the agents have not been evaluated. Nevertheless, their overall effect appears comparable with sodium cromoglycate (cromolyn sodium) or theophylline, but significantly less than low-dose inhaled corticosteroids. Antileukotrienes have been shown to have a degree of corticosteroid-sparing effect, but salmeterol appears to perform better as an add-on drug. Montelukast is probably the most useful antileukotriene for continuous treatment of exercise-induced asthma, performing as well as salmeterol without inducing any tolerance. All antileukotrienes are taken orally; their frequency of administration is quite different ranging from four times daily (zileuton) to once daily (montelukast). Antileukotrienes are well tolerated drugs, even though zileuton intake has been related to transitional liver enzyme elevations in some cases. Also Churg-Strauss syndrome

  18. Modeling and Management of Big Data: Challenges and opportunities

    OpenAIRE

    Gil Méndez, David; Song, Il-Yeol

    2016-01-01

    The term Big Data denotes huge-volume, complex, rapid growing datasets with numerous, autonomous and independent sources. In these new circumstances Big Data bring many attractive opportunities; however, good opportunities are always followed by challenges, such as modelling, new paradigms, novel architectures that require original approaches to address data complexities. The purpose of this special issue on Modeling and Management of Big Data is to discuss research and experience in modellin...

  19. Self-Management Behaviors among Older Adults with Asthma: Associations with Health Literacy

    Science.gov (United States)

    Federman, Alex D.; Wolf, Michael S.; Sofianou, Anastasia; Martynenko, Melissa; O’Connor, Rachel; Halm, Ethan A.; Leventhal, Howard; Wisnivesky, Juan P.

    2014-01-01

    Background/Objectives: Older adults asthmatics experience high rates of morbidity and mortality yet little is known about their self-management behaviors. We examined self-management behaviors, including medication adherence and inhaler technique, among older adults and their association with health literacy. Design: Observational cohort study. Setting: Primary care and pulmonary specialty practices in two tertiary academic medical centers and three Federally Qualified Health Centers in New York City, NY and Chicago, IL. Participants: Adults with moderate or severe persistent asthma, ages 60 years and older (n=433). Measurements: Outcomes were adherence to asthma controller medications, metered dose inhaler (MDI) and dry powder inhaler (DPI) techniques, having a usual asthma physician, and avoidance of four common triggers. Health literacy was assessed with the Short Test of Functional Health Literacy in Adults. Results: The mean age was 67 years and 36% had marginal or low health literacy. Adherence was low (38%) overall and worse among individuals with low health literacy (22% vs. 47%, p<0.0001) and after adjusting for demographic factors and health status (odds ratio [OR] 0.48, 95% confidence [CI] 0.31-0.73). Similarly, inhaler technique was poor: only 38% and 54% had good MDI and DPI technique, respectively. Technique was worse among those with low health literacy (MDI technique: OR 0.57, 95% CI 0.38-0.85; DPI technique: OR 0.42, 95% CI 0.25 to 0.71). Asthma self-monitoring and avoidance of triggers occurred infrequently but were less consistently associated with low health literacy. Conclusion: Adherence to medications and inhaler technique are poor among older asthmatics, and worse among those with low health literacy. Clinicians should routinely assess controller medication adherence and inhaler technique, and use low-literacy communication strategies to support self-management in older asthmatics. PMID:24779482

  20. Preparation and standardization of a herbal agent for the therapeutic management of asthma.

    Science.gov (United States)

    Emeje, Martins; Izuka, Amaka; Isimi, Christiana; Ofoefule, Sabinus; Kunle, Olobayo

    2011-04-01

    This study aims to develop a suitable single tablet dosage form containing a mixture of hot water stem back extracts of Anogeissus leiocarpus and Prosopis africana (AA1), suitable for use in the therapeutic management of asthma. The compaction characteristics of the oven-dried hot water extract (HWE) were studied using the Heckel equation. The mechanical properties as well as disintegration and dissolution profile of the compacts were also assessed. The results showed that AA1 exhibited high densification due to dye filling while the subsequent rearrangement of the granules did not contribute, significantly, to their densification. The granules had enhanced plasticity as shown by the low yield point, Py. The tablets produced from the extract had good mechanical properties, with hardness increasing with compression pressure while the friability decreased. Of the four disintegrants tested, tablets containing Explotab had the shortest disintegration time of 11 min while tablets containing Prosolv had the longest disintegration time of 40 min. The order of disintegrant property is Explotab > Cellactose > Emcocel > Maize starch > Prosolv. Dissolution results (t(90%)) show that tablets containing Explotab released 100% of the drug in 20 min proving to be the most suitable in acute asthma attack. The order of dissolution is Explotab > Cellactose > Maize starch > Prosolv > Emcocel. It is concluded that incorporation of Explotab (10%w/w) as a disintegrant in AA1 preparation produced tablets of suitable compressional properties and ensured adequate drug release for the management of acute asthma. PMID:20141501

  1. Hospital overcrowding: an opportunity for case managers.

    Science.gov (United States)

    Simmons, Florence M

    2005-01-01

    Hospital overcrowding is primarily a shortage of inpatient beds, not a lack of emergency department capacity, as initially assumed. According to Asplin et al., many factors contribute to overcrowding, including inadequate or inflexible nurse-to-patient staffing ratios, isolation precautions, or delays in cleaning rooms after patient discharge; an overreliance on intensive care or telemetry beds; inefficient diagnostic and ancillary services on inpatient units; and delays in discharging hospitalized patients to postacute-care facilities. Hospital overcrowding presents a challenge for hospital employees and clients, often leading to frustration and dissatisfaction. Overcrowding also has a direct effect on patient care, including compromised patient safety, increased costs, increased length of stay, and increased mortality and morbidity rates. The emergency department is changed from a temporary holding area to an extended patient care unit, decreasing its ability to handle new admissions and to manage a mass casualty. Beds in the critical care units become filled with inappropriate patients if floor beds are not available, making placement of seriously ill patients difficult. Trauma patients may have to be diverted to other hospitals to receive the appropriate level of care. Patients who require specialty services may have to wait for extended periods to obtain a bed in a referral center.

  2. [Guidelines for the diagnosis and management of bronchial asthma--a comparison of the Japanese guidelines for the adult asthma with GINA and ICR].

    Science.gov (United States)

    Kabe, J

    1996-11-01

    Although the concept of asthma management of the Japanese Guidelines is basically similar in the other guidelines including GINA, ICR, of British Thoracic Society, and of the other countries, assuming that asthma is a chronic inflammatory disorder of the airway, the program of stepwise pharmacologic therapy is not the same in various points. Therapy suggested in the Japanese Guidelines is different in 1) oral antiallergic drugs are widely used, 2) patients prefer oral bronchodilators to inhaled bronchodilators, 3) sustained released theophylline in the long term management and intravenous infusion of aminophylline for the treatment of acute exacerbation are accepted and frequently used by the physicians. Also the differences in the choice of medication between GINA, which is characterized by concept of cost, and other guidelines are discussed.

  3. Research Data Management and Libraries:Opportunities, Challenges, & Best Practices

    OpenAIRE

    Tsang, Daniel C

    2012-01-01

    This paper addresses how working on research data management and data sharing gives libraries an unparalleled entrée into the research scholar’s network. I believe libraries must grasp this opportunity to collaborate with faculty researchers because we are in the business of making research products accessible and shareable. In many countries of the PRDLA membership, government mandates on data management and data sharing, especially for sponsored research, makes it urgent that libraries gear...

  4. Forced Displacement : Moving from Managing Risk to Facilitating Opportunity

    OpenAIRE

    Lakhani, Sadaf

    2013-01-01

    Displacement is most commonly perceived as a situation of crisis; a time in which risks to the displaced and to host communities need to be mitigated and managed. However, if managed well, displacement can also bring new opportunities for the displaced and host communities to improve their lives. This paper looks at the predominant reasons why displacement is viewed and assisted by the aid community as a humanitarian issue, rather than as a phenomenon for which development thinking and develo...

  5. Nocturnal Asthma

    Science.gov (United States)

    ... Medical Director, Health Initiatives View full profile Nocturnal Asthma Worsening of asthma at night, or nocturnal asthma, ... give extra protection during the night. More Nocturnal Asthma Information Back to Asthma: Types Print Page Email ...

  6. Asthma Basics

    Science.gov (United States)

    ... Tropical Delight: Melon Smoothie Pregnant? Your Baby's Growth Asthma Basics KidsHealth > For Parents > Asthma Basics Print A ... Asthma Categories en español Asma: aspectos fundamentales About Asthma Asthma is a common lung condition in kids ...

  7. 78 FR 73820 - Publicly Managed Recreation Opportunities, Recreation Fees

    Science.gov (United States)

    2013-12-09

    ... Forest Service RIN 0596-AD09 Publicly Managed Recreation Opportunities, Recreation Fees AGENCY: Forest... final directive providing direction on recreation fees in chapter 30 of new Forest Service Handbook (FSH) 2309.13. This chapter enumerates the requirements for recreation fees charged by the Forest...

  8. A randomized controlled trial to assess the clinical and cost effectiveness of a nurse-led Antenatal Asthma Management Service in South Australia (AAMS study)

    OpenAIRE

    Grzeskowiak, Luke E; Dekker, Gustaaf; Rivers, Karen; Roberts-Thomson, Kate; Roy, Anil; Smith, Brian; Bowden, Jeffery; Bryce, Robert; Davies, Michael; Beilby, Justin; Wilson, Anne; Middleton, Philippa; Ruffin, Richard; Karnon, Jonathan; Clifton, Vicki L.

    2014-01-01

    Background Pregnancy presents a unique situation for the management of asthma as it can alter the course of asthma severity and its treatment, which in turn can affect pregnancy outcomes. Despite awareness of the substantial adverse effects associated with asthma during pregnancy, little has been done to improve its management and reduce associated perinatal morbidity and mortality. The aim of this randomized controlled trial is to evaluate the clinical and cost effectiveness of an Antenatal ...

  9. Identifying asthma triggers.

    Science.gov (United States)

    McCarty, Justin C; Ferguson, Berrylin J

    2014-02-01

    Asthma has many triggers including rhinosinusitis; allergy; irritants; medications (aspirin in aspirin-exacerbated respiratory disease); and obesity. Paradoxic vocal fold dysfunction mimics asthma and may be present along with asthma. This article reviews each of these triggers, outlining methods of recognizing the trigger and then its management. In many patients more than one trigger may be present. Full appreciation of the complexity of these relationships and targeted therapy to the trigger is needed to best care for the patient with asthma.

  10. Examining causes of the urban (inner city) asthma epidemic: Implementing new management strategies.

    Science.gov (United States)

    Szefler, Stanley J

    2016-01-01

    Asthma in the inner city contributes to high morbidity and mortality, and, in school children, reduced school attendance and alteration in academic performance. There is a need to improve asthma care in the inner city by reducing asthma exacerbations. Methods are currently available to predict and prevent seasonal exacerbations of asthma. In addition, new medications are being developed that will be effective in improving pulmonary function and reducing asthma exacerbations. School-centered asthma programs can also be helpful to assist children and clinicians in applying asthma treatment plans and assuring optimal adherence to these plans. PMID:26831839

  11. Management of the patient with eosinophilic asthma: a new era begins

    OpenAIRE

    Jantina C. de Groot; Anneke ten Brinke; Elisabeth H.D. Bel

    2015-01-01

    Now that it is generally accepted that asthma is a heterogeneous condition, phenotyping of asthma patients has become a mandatory part of the diagnostic workup of all patients who do not respond satisfactorily to standard therapy with inhaled corticosteroids. Late-onset eosinophilic asthma is currently one of the most well-defined asthma phenotypes and seems to have a different underlying pathobiology to classical childhood-onset, allergic asthma. Patients with this phenotype can be identifie...

  12. Acute adult asthma--assessment of severity and management and comparison with British Thoracic Society Guidelines.

    Science.gov (United States)

    Hart, S R; Davidson, A C

    1999-01-01

    To investigate the accuracy of clinical severity assessment of asthmatics and to compare emergency and subsequent ward management with British Thoracic Society (BTS) Guidelines, the records of all patients admitted for severe asthma (46) over a 5-month period to a District General Hospital were inspected. Variations from recommended management were revealed. Appropriate oxygen administration was often not provided in casually and patients frequently left hospital before their discharge criteria were attained: recommended diurnal variations in peak flow were exceeded in 26%. Eleven per cent of discharges were against medical advice, making provision of adequate management logistically difficult. Adherence to BTS guidelines on the need for arterial blood gas (ABG) analysis would have led to a failure to detect significant hypoxaemia in 25% of cases. This study identified substantial variations from BTS management guidelines. It is suggested that oximetry is necessary on arrival to guide selection for arterial blood gas analysis.

  13. From Risk Management to Opportunity Management: An Institutional Approach

    OpenAIRE

    Dang, My

    2015-01-01

    As Institutions has become an important research topic, the motivation to understand the institutional environment in a particular economy and how firms adapt to this environment created a background for the thesis. Vietnam, as an emerging economy, is an ideal example of a weak institutional system. By reviewing relevant literature in the fields of institutions and risk management, the study developed a theoretical framework of effective management strategies for firms to exploit opportunitie...

  14. A local perspective to asthma management in the accident and emergency department in Malta

    Directory of Open Access Journals (Sweden)

    Caroline Gouder

    2013-01-01

    Full Text Available Aim: This study was performed to assess the management of adult patients presenting to the Mater Dei Hospital Accident and Emergency (A&E department with acute asthma. Subjects and Methods: Asthmatic patients age 14 or older who presented to A&E department between January and October 2010 with asthma exacerbations were included. Data were collected from the clinical notes and analyzed. Results: A total of 244 patients (67.2% females were included, 126 (51.6% were admitted, 97 (39.8% discharged and 21 (8.6% discharged themselves against medical advice. There was a decline in the presentations between January and July, followed by an upward trend until October (P = 0.42. Pulse oximetry was performed in 207 patients (84.8%, arterial blood gases in 133 (54.5%, peak expiratory flow rate in 106 (43.4% and chest radiography in 206 (84.4% patients. The respiratory rate was documented in 151 (61.8%, heart rate in 204 (83.6% and ability to complete sentences in 123 (50.4% patients. One hundred and ninety six patients (80.3% were given nebulized bronchodilators, 103 (42.2% intravenous corticosteroids, 7 (2.87% oral corticosteroids, 109 (44.7% oxygen, 28 (11.5% antibiotics and 9 (3.69% magnesium. Systemic corticosteroids and antibiotics were more commonly prescribed to patients admitted (P < 0.001. Conclusion: Management of acute asthma in Malta requires optimization in order to compare with international guidelines.

  15. Radioactive Waste Management Challenges and Opportunities in the United Kingdom

    International Nuclear Information System (INIS)

    Since 1956, 44 nuclear reactors have been built in the United Kingdom; 26 of which are Magnox Power Stations owned by the Nuclear Decommissioning Authority. Twenty-two NDA reactors are currently in decommissioning phase with the remaining four scheduled for decommissioning by 2010. Estimates are 2 million m3 of low level waste (LLW) and 350,000 m3 intermediate level wastes (ILW) will be generated during decommissioning activities. Supporting an accelerated schedule poses both challenges and opportunities including transitioning from generation to final site clearance with a workforce inexperienced in decommissioning; insufficient in-country waste management treatment capabilities and disposal capacities; limited Company experience in waste management, decontamination, reclassification and innovative treatment technologies; and ongoing requirements for flexible regulatory strategy that both Regulators and Stakeholders accept. Delivery of safe, innovative streamlined projects and global benchmarking of similar Defueling and Decommissioning (D and D) activities has been initiated. As transition from power generation power to D and D occurs, emphasis will be on performing decommissioning work and utilising various waste management technologies and opportunities. Considerations include utilisation of different approaches to concrete remediation; installation of on-site low level waste storage facilities with repacking, size reduction and decontamination capabilities; inter-site waste transfers of waste for consolidated management; on-site disposal capability; implementation of more efficient waste characterisation and tracking management systems and tools; and new off-site waste management treatment/disposal capabilities. (authors)

  16. Do Written Asthma Action Plans Improve Outcomes?

    OpenAIRE

    Kelso, John M.

    2016-01-01

    With appropriate management, children with asthma should expect few symptoms, no limits on activity, rare exacerbations, and normal lung function. Appropriate education of parents and other caregivers of children with asthma has clearly been shown to help achieve these goals. Although recommended in asthma guidelines, providing written asthma action plans does not improve outcomes beyond asthma education alone.

  17. Know How to Use Your Asthma Inhaler

    Medline Plus

    Full Text Available ... Brochures Facts Triggers Indoors In the Workplace Outdoors Management Asthma Action Plan Flu Shots Inhalers Data, Statistics, ... Asthma NCHS Asthma FastStats Survey Questions Resources for Health Professionals and Schools Healthcare Professionals Public Health Professionals ...

  18. Know How to Use Your Asthma Inhaler

    Medline Plus

    Full Text Available ... Triggers Indoors In the Workplace Outdoors Management Asthma Action Plan Flu Shots Inhalers Data, Statistics, and Surveillance ... gaining control over their asthma. Quick Links Asthma Action Plan America Breathing Easier [PDF - 1.1 MB] ...

  19. Do accident and emergency senior house officers know the British guidelines on the management of acute asthma?

    Science.gov (United States)

    Ulahannan, T; Hardern, R D; Hamer, D W

    1996-03-01

    Avoidable deaths from asthma continue, even in hospital. Since the management of acute severe asthma is often initiated in the Accident and Emergency department, it is crucial that staff there have adequate knowledge. An anonymous questionnaire, containing items based on chart 6 of the UK guidelines, was completed by 66 Accident and Emergency Senior House Officers from the Yorkshire region. The study aim was to establish these doctors' levels of knowledge about the recommended management of acute asthma in Accident and Emergency. The median score was 10 (out of a possible 24) and the interquartile range 8-13. Further efforts are required to implement these guidelines so that the best patient outcomes can be achieved.

  20. Screening for asthma in children.

    OpenAIRE

    Jones, A.

    1994-01-01

    The primary health care team is at the forefront of asthma management and there is evidence of improved delivery of care via nurse run, audited, general practice clinics. However, hospital admissions for asthma continue to rise. Screening for childhood asthma would appear to have advantages for patient care. This review looks critically at the literature that addresses important issues in screening for childhood asthma, including the problem of defining asthma, its prevalence rate and the imp...

  1. Illness perceptions : impact on self-management and control in asthma

    NARCIS (Netherlands)

    Kaptein, Ad A.; Klok, Ted; Moss-Morris, Rona; Brand, Paul L. P.

    2010-01-01

    Purpose of review Outcome in asthma is determined not only by pulmonary function or other biomedical characteristics. An important determinant of asthma outcome is illness perceptions: patients' subjective beliefs and emotional responses to their illness. Illness perceptions influence patients' copi

  2. Paediatric acute asthma management in Australia and New Zealand : practice patterns in the context of clinical practice guidelines

    NARCIS (Netherlands)

    Babl, F. E.; Sheriff, N.; Borland, M.; Acworth, J.; Neutze, J.; Krieser, D.; Ngo, P.; Schutz, J.; Thomson, F.; Cotterell, E.; Jamison, S.; Francis, P.

    2008-01-01

    Objectives: To compare clinical practice guideline (CPG) recommendations and reported physician management of acute paediatric asthma in the 11 largest paediatric emergency departments, all of which have CPGs, in Australia (n= 9) and New Zealand (n= 2). All 11 sites participate in the Paediatric Res

  3. Difficult asthma.

    OpenAIRE

    Ahmet Uslu; Tülay Özdemir

    1989-01-01

    Difficult asthma is a distinct entity of asthma, comprising approximately %5 of asthmatic patients. There is no agreed definition of difficult asthma. It will include asthma uncontrolled by new standard therapy, steroid dependent, steroid resistant and severe asthma. In this study difficult asthma; clinical features, risk factors, pathophysiology and novel therapies are summarized by literatures.

  4. Opportunity Cost of Surgical Management of Craniomaxillofacial Trauma.

    Science.gov (United States)

    Moses, Helen; Powers, David; Keeler, Jarrod; Erdmann, Detlev; Marcus, Jeff; Puscas, Liana; Woodard, Charles

    2016-03-01

    The provision of trauma care is a financial burden, continually associated with low reimbursement, and shifts the economic burden to major trauma centers and providers. Meanwhile, the volume of craniomaxillofacial (CMF) trauma and the number of surgically managed facial fractures are unchanged. Past financial analyses of cost and reimbursement for facial trauma are limited to mandibular and midface injuries, consistently revealing low reimbursement. The incurred financial burden also coincides with the changing landscape of health insurance. The goal of this study is to determine the opportunity cost of operative management of facial trauma at our institution. From our CMF database of greater than 3,000 facial fractures, the physician charges, collections, and relative value units (RVUs) for CMF trauma per year from 2007 to 2013 were compared with a general plastic surgery and otolaryngology population undergoing operative management during this same period. Collection rates were analyzed to assess if a significant difference exists between reimbursement for CMF and non-CMF cases. Results revealed a significant difference between the professional collection rate for operative CMF trauma and that for other operative procedures (17.25 vs. 29.61%, respectively; p opportunity cost associated with offering this service is a potential threat to the sustainability of providing care for this population. PMID:26889352

  5. Knowledge management at the IAEA - Challenges and opportunities

    International Nuclear Information System (INIS)

    Full text: 'Knowledge Management caters to the critical issues of organizational adaptation, survival and competence in face of increasingly discontinuous change of environment. Essentially, it embodies organizational processes that seek synergistic combination of data and information processing capacity of information technologies, and the creative and innovative capacity of human beings' (Malhotra 1997). International organizations are coming to view knowledge as their most valuable and strategic resource, and bringing that knowledge to bear on problems and opportunities as their most important capability. It is being realised that to remain geared to the evolving needs of their Member States it is a must to explicitly manage all intellectual resources and capabilities of the organization. To this end, many international organizations have initiated a range of knowledge management projects and programs. The primary focus of these efforts has been on developing new applications of information technology to support the digital capture, storage, retrieval and distribution of an organization's documented knowledge but also capturing valuable tacit knowledge existing within peoples' heads, augmented or shared via interpersonal interaction and social relationships. Numerous technical and organizational initiatives have been aligned and integrated, providing a comprehensive infrastructure to support knowledge management processes. But while the appropriate infrastructure can enhance an organization's ability to create and exploit knowledge, it does not insure that the organization is making the best investment of its resources or that it is managing the right knowledge in the right way. Against the background of these trends and the opportunities and challenges they present, the Agency has been active in establishing knowledge management as a crosscutting activity that includes both assisting Member States in managing their own nuclear knowledge assets but also in

  6. Montelukast versus inhaled corticosteroids in the management of pediatric mild persistent asthma

    Directory of Open Access Journals (Sweden)

    Scaparrotta Alessandra

    2012-07-01

    Full Text Available Abstract International guidelines recommend the use of inhaled corticosteroids (ICSs as the preferred therapy, with leukotriene receptor antagonists (LTRAs as an alternative, for the management of persistent asthma in children. Montelukast (MLK is the first LTRA approved by the Food and Drug Administration for the use in young asthmatic children. Therefore, we performed an analysis of studies that compared the efficacy of MLK versus ICSs. We considered eligible for the inclusion randomized, controlled trials on pediatric populations with Jadad score > 3, with at least 4 weeks of treatment with MLK compared with ICS. Although it is important to recognize that ICSs use is currently the recommended first-line treatment for asthmatic children, MLK can have consistent benefits in controlling asthmatic symptoms and may be an alternative in children unable to use ICSs or suffering from poor growth. On the contrary, low pulmonary function and/or high allergic inflammatory markers require the corticosteroid use.

  7. Asthma and pregnancy.

    Science.gov (United States)

    Vatti, Rani Reddy; Teuber, Suzanne S

    2012-08-01

    Asthma is probably the most common serious medical disorder that may complicate pregnancy. A third of pregnant women with asthma will experience worsening of their symptoms, a third will see improvement of their symptoms and a third will see no change. The primary goal is to maintain optimal control of asthma for maternal health and well-being as well as fetal maturation. Vital patient education should cover the use of controller medication, avoidance of asthma triggers and early treatment of asthma exacerbations. Proper asthma management should ideally be started in the preconception period. Since smoking is probably the most modifiable risk factor of asthma, pregnant woman should avoid active and passive smoking. Acute asthma exacerbation during the first trimester is associated with an increased risk of congenital malformations. Poorly controlled asthma is associated with low birth weight, preeclampsia, and preterm birth. Medications used for asthma control in the non-pregnant population are generally the same in pregnancy with a few exceptions. Inhaled corticosteroids (ICS) are the preferred controller therapy. Budesonide is the preferred ICS. Long-acting B-agonists (LABA) are the preferred add-on therapy to medium to high dose ICS. Major triggers for asthma exacerbations during pregnancy are viral infections and ICS nonadherence. PMID:21858482

  8. Knowledge management at the IAEA - Challenges and opportunities

    International Nuclear Information System (INIS)

    Full text: ['Knowledge Management caters to the critical issues of organizational adaptation, survival and competence in face of increasingly discontinuous change of environment. Essentially, it embodies organizational processes that seek synergistic combination of data and information processing capacity of information technologies, and the creative and innovative capacity of human beings'. (Malhotra 1997).] International organizations are coming to view knowledge as their most valuable and strategic resource, and bringing that knowledge to bear on problems and opportunities as their most important capability. It is being realised that to remain geared to the evolving needs of their Member States it is a must to explicitly manage all intellectual resources and capabilities of the organization. To this end, many international organizations have initiated a range of knowledge management projects and programs. The primary focus of these efforts has been on developing new applications of information technology to support the digital capture, storage, retrieval and distribution of an organization's documented knowledge but also capturing valuable tacit knowledge existing within peoples' heads, augmented or shared via interpersonal interaction and social relationships. The concept of building and utilizing intellectual and 'social capital' that develops from people i.e., new organizational cultures, forms and reward systems to enhance those social relationships has been implemented. Technical and organizational initiatives, when aligned and integrated, can provide a comprehensive infrastructure to support knowledge management processes. But while the appropriate infrastructure can enhance an organization's ability to create and exploit knowledge, it does not insure that the organization is making the best investment of its resources or that it is managing the right knowledge in the right way. Against the background of these trends and the opportunities and challenges

  9. E-LEARNING CHANGE MANAGEMENT: Challenges and opportunities

    Directory of Open Access Journals (Sweden)

    Alaattin PARLAKKILIC

    2013-10-01

    Full Text Available The role of e-learning technologies entirely depends on the acceptance and execution of required-change in the thinking and behaviour of the users of institutions. The research are constantly reporting that many e-learning projects are falling short of their objectives due to many reasons but on the top is the user resistance to change according to the digital requirements of new era. It is argued that the suitable way for change management in e-learning environment is the training and persuading of users with a view to enhance their digital literacy and thus gradually changing the users’ attitude in positive direction. This paper discusses change management in transition to e-learning system considering pedagogical, cost and technical implications. It also discusses challenges and opportunities for integrating these technologies in higher learning institutions with examples from Turkey GATA (Gülhane Askeri Tıp Akademisi-Gülhane Military Medical Academy.

  10. Asthma in Adolescents: A Randomized, Controlled Trial of an Asthma Program for Adolescents and Young Adults with Severe Asthma

    OpenAIRE

    Robert L Cowie; Underwood, Margot F; Little, Cinde B; Ian Mitchell; Sheldon Spier; Ford, Gordon T

    2002-01-01

    BACKGROUND: Asthma is common and is often poorly controlled in adolescent subjects.OBJECTIVE: To determine the impact of an age-specific asthma program on asthma control, particularly on exacerbations of asthma requiring emergency department treatment, and on the quality of life of adolescents with asthma.METHODS: The present randomized, controlled trial included patients who were 15 to 20 years of age and had visited emergency departments for management of their asthma. The interventional gr...

  11. Assessing the risk of attack in the management of asthma: a review and proposal for revision of the current control-centred paradigm.

    Science.gov (United States)

    Blakey, John D; Woolnough, Kerry; Fellows, Jodie; Walker, Samantha; Thomas, Mike; Pavord, Ian D

    2013-09-01

    Asthma guidelines focus on day-to-day control of symptoms. However, asthma attacks remain common. They continue to cause mortality and considerable morbidity, and are a major financial burden to the UK National Health Service (NHS) and the wider community. Asthma attacks have chronic consequences, being associated with loss of lung function and significant psychological morbidity. In this article we argue that addressing daily symptom control is only one aspect of asthma treatment, and that there should be a more explicit focus on reducing the risk of asthma attacks. Management of future risk by general practitioners is already central to other conditions such as ischaemic heart disease and chronic renal impairment. We therefore propose a revised approach that separately considers the related domains of daily control and future risk of asthma attack. We believe this approach will have advantages over the current 'stepwise' approach to asthma management. It should encourage individualised treatment, including non-pharmacological measures, and thus may lead to more efficacious and less harmful management strategies. We speculate that this type of approach has the potential to reduce morbidity and healthcare costs related to asthma attacks.

  12. The WISE Satellite Development: Managing the Risks and the Opportunities

    Science.gov (United States)

    Duval, Valerie G.; Elwell, John D.; Howard, Joan F.; Irace, William R.; Liu, Feng-Chuan

    2010-01-01

    NASA's Wide-field Infrared Survey Explorer (WISE) MIDEX mission is surveying the entire sky in four infrared bands from 3.4 to 22 micrometers. The WISE instrument consists of a 40 cm telescope, a solid hydrogen cryostat, a scan mirror mechanism, and four 1K x1K infrared detectors. The WISE spacecraft bus provides communication, data handling, and avionics including instrument pointing. A Delta 7920 successfully launched WISE into a Sun-synchronous polar orbit on December 14, 2009. WISE was competitively selected by NASA as a Medium cost Explorer mission (MIDEX) in 2002. MIDEX missions are led by the Principal Investigator who delegates day-to-day management to the Project Manager. Given the tight cost cap and relatively short development schedule, NASA chose to extend the development period one year with an option to cancel the mission if certain criteria were not met. To meet this and other challenges, the WISE management team had to learn to work seamlessly across institutional lines and to recognize risks and opportunities in order to develop the flight hardware within the project resources. In spite of significant technical issues, the WISE satellite was delivered on budget and on schedule. This paper describes our management approach and risk posture, technical issues, and critical decisions made.

  13. A controlled trial of a school-based intervention to improve asthma management.

    Science.gov (United States)

    McCann, D C; McWhirter, J; Coleman, H; Calvert, M; Warner, J O

    2006-05-01

    The present study investigated schools as an appropriate context for an intervention designed to produce clinical and psychological benefits for children with asthma. A total of 193 out of 219 (88.1%) children with asthma (aged 7-9 yrs) from 23 out of 24 (95.8%) schools completed the study. Intervention schools received a staff asthma-training session, advice on asthma policy, an emergency beta2-agonist inhaler with spacer and whole-class asthma workshops. Nonintervention schools received no asthma-related input. Intervention children required less general practitioner-prescribed preventer medication despite no differences in symptom control compared with the nonintervention asthmatic group. Increased peer knowledge of asthma may have mediated improved active quality of life in the intervention group, together with increased self-esteem in young females. Those females not receiving the intervention, but identified as being asthmatic within the classroom, and thus possibly stigmatised, reported decreased self-esteem. Lower self-esteem in young males was associated with pet ownership. No change was found in staff knowledge, the establishment of asthma policies or school absences which were low even before intervention. In conclusion, a whole-school intervention can improve the health of children with asthma when followed with support for all children but effects are likely to be modified by sex and the home environment. PMID:16455821

  14. A knowledge management journey at BNG Sellafield: Challenges and opportunities

    International Nuclear Information System (INIS)

    Full text: All organisations manage knowledge in some shape of form. Over the last decade BNFL and latterly BNG, has undertaken a number of business improvement initiatives, however it was not until the late 1990's that a formal integrative KM programme was sanctioned. Great progress was made with the chief aims of a broadly based KM programme with setting up of electronic 'team rooms', improved database searching and 'Learning from experience' processes and an embryonic 'yellow pages' system etc. By 2001, following major reorganisations of the business, Knowledge Management was classified as a 'Cross-business issue'. Consequently, the decision was made to withdraw the Group Office co-ordination and resourcing of Knowledge Management in BNFL. There were no further significant developments until 2006, when there was an explicit request from the Nuclear Decommissioning Authority (NDA) for all nuclear site license holders (including BNG Sellafield) to manage knowledge and intellectual property effectively (NDA, 2005; 2006a; 2006b). This policy posed several challenges for BNG Sellafield: - Demonstrating that knowledge and good practise was being leveraged not only at each nuclear site but across the whole of the NDA's portfolio of 20 geographically and organisationally separated sites; - Demonstrating that the considerable body of Intellectual property and associated rights was being managed for the benefit of the nation and in such a way that promoted Innovation in an industry where increased competition was being encouraged; - The plethora of conceptual frameworks and definitions of knowledge management suggested a lack of uniformity as to what constitutes knowledge management; let alone how to implement such a programme. Our solution was to employ a knowledge transfer process from experienced consultants and trainers to an internal team charged with the implementation of knowledge management at Sellafield. Our brief was to design and deliver a two year programme

  15. Mobile phone-based asthma self-management aid for adolescents (mASMAA: a feasibility study

    Directory of Open Access Journals (Sweden)

    Rhee H

    2014-01-01

    Full Text Available Hyekyun Rhee,1 James Allen,2 Jennifer Mammen,1 Mary Swift21School of Nursing, 2Department of Computer Science, University of Rochester, Rochester, NY, USAPurpose: Adolescents report high asthma-related morbidity that can be prevented by adequate self-management of the disease. Therefore, there is a need for a developmentally appropriate strategy to promote effective asthma self-management. Mobile phone-based technology is portable, commonly accessible, and well received by adolescents. The purpose of this study was to develop and evaluate the feasibility and acceptability of a comprehensive mobile phone-based asthma self-management aid for adolescents (mASMAA that was designed to facilitate symptom monitoring, treatment adherence, and adolescent–parent partnership. The system used state-of-the-art natural language-understanding technology that allowed teens to use unconstrained English in their texts, and to self-initiate interactions with the system.Materials and methods: mASMAA was developed based on an existing natural dialogue system that supports broad coverage of everyday natural conversation in English. Fifteen adolescent–parent dyads participated in a 2-week trial that involved adolescents' daily scheduled and unscheduled interactions with mASMAA and parents responding to daily reports on adolescents' asthma condition automatically generated by mASMAA. Subsequently, four focus groups were conducted to systematically obtain user feedback on the system. Frequency data on the daily usage of mASMAA over the 2-week period were tabulated, and content analysis was conducted for focus group interview data.Results: Response rates for daily text messages were 81%–97% in adolescents. The average number of self-initiated messages to mASMAA was 19 per adolescent. Symptoms were the most common topic of teen-initiated messages. Participants concurred that use of mASMAA improved awareness of symptoms and triggers, promoted treatment adherence and

  16. 76 FR 34639 - Funding Opportunity Title: Risk Management Education and Outreach Partnerships Program...

    Science.gov (United States)

    2011-06-14

    ... Federal Crop Insurance Corporation Funding Opportunity Title: Risk Management Education and Outreach... Management Education and Outreach Partnerships Program. This Request for Applications (RFA) Announcement is... Agricultural Risk Management Education Sessions'' and the ``Community Outreach and Assistance...

  17. Biomarkers in Severe Asthma.

    Science.gov (United States)

    Wan, Xiao Chloe; Woodruff, Prescott G

    2016-08-01

    Biomarkers have been critical for studies of disease pathogenesis and the development of new therapies in severe asthma. In particular, biomarkers of type 2 inflammation have proven valuable for endotyping and targeting new biological agents. Because of these successes in understanding and marking type 2 inflammation, lack of knowledge regarding non-type 2 inflammatory mechanisms in asthma will soon be the major obstacle to the development of new treatments and management strategies in severe asthma. Biomarkers can play a role in these investigations as well by providing insight into the underlying biology in human studies of patients with severe asthma. PMID:27401625

  18. Promoting Self-Management in Adults with Asthma: An Overview of the UAB Program.

    Science.gov (United States)

    Bailey, William C.; And Others

    1987-01-01

    A study at the University of Alabama/Birmingham (UAB) compared adult asthma patients receiving a self-care workbook with those receiving only asthma pamphlets. Outcomes were assessed in five areas: (1) health care utilization, (2) functional status, (3) knowledge, (4) adherence, and (5) psychological reactions. (Author/CH)

  19. Role of leukotriene receptor antagonists in the management of pediatric asthma: an update.

    Science.gov (United States)

    Dumitru, Catalina; Chan, Susan M H; Turcanu, Victor

    2012-10-01

    At present, the main indications for leukotriene receptor antagonists (LTRA) in pediatric asthma are as add-on therapy to inhaled corticosteroids (ICS) and as initial controller therapy in children with mild asthma, especially those who cannot or will not use ICS. LTRA are also useful for patients who have concomitant rhinitis, and patients with viral-induced wheeze and exercise-induced asthma. It should be noted that the benefits of LTRA therapy have been demonstrated in children as young as 6 months of age and recent clinical trials have further proven the benefits of LTRA in acute asthma exacerbations. However, considering the important pro-inflammatory effects that leukotrienes (LT) have in experimental models of asthma, it may seem surprising that LTRA treatment outcomes are not better and that in some clinical trials only a minority of patients could be classified as full responders. This could be explained by potential additional LT receptors that are not affected by LTRA. Such receptors could represent new therapeutic targets in asthma. Furthermore, progress in differentiating between asthma phenotypes that result from different pathogenic mechanisms, some of which may involve LT to a lesser degree, should lead to an improved, personalized use of LTRA for treating asthma. PMID:22897162

  20. Evidence based guidelines for the prevention, identification, and management of occupational asthma

    OpenAIRE

    Nicholson, P; Cullinan, P.; Newman, T; Burge, P; Boyle, C.

    2005-01-01

    Background: Occupational asthma is the most frequently reported work related respiratory disease in many countries. This work was commissioned by the British Occupational Health Research Foundation to assist the Health and Safety Executive in achieving its target of reducing the incidence of occupational asthma in Great Britain by 30% by 2010.

  1. Asthma and obesity

    DEFF Research Database (Denmark)

    Ulrik, Charlotte S

    2016-01-01

    PURPOSE OF REVIEW: Obesity has significant negative impact on asthma control and risk of exacerbations. The purpose of this review is to discuss recent studies evaluating the effects of weight reduction on asthma control in obese adults. RECENT FINDINGS: Clinical studies have shown that weight...... reduction in obese patients is associated with improvements in symptoms, use of controller medication, and asthma-related quality of life together with a reduction in the risk for severe exacerbations. Furthermore, several studies have also revealed improvements in lung function and airway responsiveness...... reduction in obese adults with asthma leads to an overall improvement in asthma control, including airway hyperresponsiveness and inflammation. Weight reduction should be a cornerstone in the management of obese patients with asthma....

  2. Psychological aspects of asthma.

    Science.gov (United States)

    Lehrer, Paul; Feldman, Jonathan; Giardino, Nicholas; Song, Hye-Sue; Schmaling, Karen

    2002-06-01

    Asthma can be affected by stress, anxiety, sadness, and suggestion, as well as by environmental irritants or allergens, exercise, and infection. It also is associated with an elevated prevalence of anxiety and depressive disorders. Asthma and these psychological states and traits may mutually potentiate each other through direct psychophysiological mediation, nonadherence to medical regimen, exposure to asthma triggers, and inaccuracy of asthma symptom perception. Defensiveness is associated with inaccurate perception of airway resistance and stress-related bronchoconstriction. Asthma education programs that teach about the nature of the disease, medications, and trigger avoidance tend to reduce asthma morbidity. Other promising psychological interventions as adjuncts to medical treatment include training in symptom perception, stress management, hypnosis, yoga, and several biofeedback procedures. PMID:12090377

  3. Woodland caribou management in Alberta: historical perspectives and future opportunities

    Directory of Open Access Journals (Sweden)

    Elston H. Dzus

    2007-04-01

    Full Text Available Woodland caribou conservation has been the topic of much debate for the past few decades. By the late 1970s there was growing concern about declining woodland caribou populations and the interaction between industrial activities and woodland caribou. Initial concerns led to the closure of the licensed hunting season in 1981. Early confrontation between government and industry in the late 1980s transformed into a series of evolving collaborative ventures. Improving our understanding of the basic ecology of woodland caribou in Alberta was at the center of early research efforts; more recent studies have examined the effects of industrial activities on caribou and effectiveness of various mitigation factors. Despite having amassed an impressive body of information from a research and monitoring perspective, progress on implementing effective management actions has been less dramatic. Industry has endured significant costs implementing a variety of perceived conservation initiatives, but caribou populations continued to decline through the last few decades. While some parties feel more research is needed, there is growing consensus that changes to habitat as induced by human activities are important factors influencing current caribou declines. Predation is a proximate cause of most caribou mortality. Climate change mediated alterations to habitat and predator-prey interactions remain a key source of uncertainty relative to future caribou population trends. Management actions will need to deal with long term habitat changes associated with human land use and short term implications of increased predation. In 2005, the provincial minister responsible for caribou conservation responded to the draft 2004 recovery plan and created the Alberta Caribou Committee (ACC. The goal of the ACC is to maintain and recover woodland caribou in Alberta’s forest ecosystems while providing opportunities for resource development, following guidance provided by the

  4. Pediatric Asthma

    Science.gov (United States)

    ... MD Dept. of Pediatrics View full profile Pediatric Asthma: Overview For some children with asthma, their first ... Calendar Read the News View Daily Pollen Count Asthma Treatment Program At National Jewish Health, we offer ...

  5. What Is Asthma?

    Science.gov (United States)

    ... that it is a combination of your family history and your environment. There is no cure for asthma. Once you ... administrators with information, education and resources to incorporate environmental management into clinical practices and standards of care for asthma patients. Top ...

  6. Omalizumab in the management of patients with allergic (IgE-mediated asthma

    Directory of Open Access Journals (Sweden)

    Thomas Sandström

    2009-05-01

    Full Text Available Thomas SandströmDepartment of Respiratory Medicine and Allergy, University Hospital, Umeå, SwedenAbstract: Immunoglobulin E (IgE is central to the pathophysiology of allergic asthma. Omalizumab, an anti-IgE monoclonal antibody, binds to the FcεRI binding site on free IgE. As a result, circulating free IgE is reduced, IgE is prevented from attaching to mast cells and basophils, and FcεRI receptor expression is down-regulated. The inflammatory response to allergens and the acute and chronic effector phases of allergic inflammation are thereby attenuated. In clinical trials in adults and adolescents, omalizumab reduced asthma exacerbations, severe asthma exacerbations, inhaled corticosteroid requirements, and emergency visits, as well as significantly improving asthma-related quality of life, morning peak expiratory flow and asthma symptom scores in patients with severe allergic (IgE-mediated asthma. Results from clinical trials in children (< 12 years are consistent with those in the adult population. It is difficult to predict which patients will respond to omalizumab. Responders to omalizumab should be identified after a 16-week trial of therapy using the physician’s overall assessment. When treatment is targeted to these responders, omalizumab provides a cost-effective therapy for inadequately controlled severe allergic (IgE-mediated asthma. Long-term therapy with omalizumab shows the potential for disease-modification in asthma. Ongoing studies are also evaluating the use of omalizumab in other non-asthma IgE-mediated conditions.Keywords: omalizumab, IgE, allergic asthma

  7. ‘‘I just forget to take it’’: asthma self-management needs and preferences in adolescents.

    OpenAIRE

    Koster, E.S.; Philbert, D.; Van Dijk, L; Vries, T.W. de; Bouvy, M.L.

    2015-01-01

    Background: Medication adherence rates often decline as children become teenagers. Effective adherence-enhancing interventions for adolescents are lacking. The objective of this study was to assess adolescent asthmatics needs and preferences regarding medication counseling and support, with focus on new media. Methods: Three focus groups including 21 asthmatic adolescents recruited from both primary and secondary care were held to explore needs and preferences regarding asthma-self management...

  8. Cultural perspectives of interventions for managing diabetes and asthma in children and adolescents for ethnic minority groups

    OpenAIRE

    McManus, Vicki; Savage, Eileen

    2010-01-01

    Both diabetes and asthma are increasingly being recognized as health problems for ethnic groups. Because of cultural differences, ethnicity is reported to be a risk factor for poorer quality in healthcare, disease management and disease control. Ethnic groups are at risk for poorer quality of life and increased disease complications when compared with non-ethnic counterparts living in the same country. There is little known about how culture is addressed in interventions developed for ethnic ...

  9. The Asthma Cost in Oman

    OpenAIRE

    Soriano, Joan B; Zulfikar Habibullah; Al-Busaidi, Nasser H.

    2013-01-01

    Objectives: This study evaluates the direct costs of treating asthma in Oman. Methods: Asthma prevalence and unit cost estimates were based on results from a panel using the Delphi technique, and were appliedto the total Omani population aged 5 and older to obtain the number of people diagnosed with asthma. The estimates from the Delphi exercise were multiplied by the percentage of patients using government facilities to estimate the number of asthma patients managed in Oman. Treatment costs ...

  10. Demand Management Opportunities in E-fulfillment: What Internet Retailers Can Learn from Revenue Management

    NARCIS (Netherlands)

    N.A.H. Agatz (Niels); A. Campbell; M. Fleischmann (Moritz); J.A.E.E. van Nunen (Jo); M.W.P. Savelsbergh (Martin)

    2008-01-01

    textabstractIn this paper, we explain how Internet retailers can learn from proven revenue management concepts and use them to reduce costs and enhance service. We focus on attended deliveries as these provide the greatest opportunities and challenges. The key driver is service differentiation. Reve

  11. Fuel cells and electricity companies - new risk management opportunities

    International Nuclear Information System (INIS)

    'Full text:' Deregulation, distributed generation, combined heat and power, renewables, fuel cells, hydrogen. Power companies are facing a rapidly evolving environment that is testing their ability to effectively deploy capital and earn profits. While recent deregulation trends have shifted the structure of power markets into separating generators from distributors, the improving economic value proposition offered by smaller scale distributed generation technologies - such as fuel cells - would seem to be a conflicting development. In this complex and changing environment, decisions based on the economic reality of the capital markets are likely to prevail. By examining the opportunity to enhance risk management offered by stationary fuel cells, particularly in CHP applications, we provide a context for the issues being discussed in today's sessions focusing on power companies and electric utilities. Our risk management perspective suggests a pathway for implementing fuel cells in combined heat and power applications that large power generators can introduce in increasingly smaller sizes. With capital costs of fuel cells high and risk tolerance of power companies low, the challenge for smaller technology developers will be to reduce the apparently long time horizon that persists for substantial deployment. (author)

  12. Accountability in an information age : opportunities and risks for records management

    OpenAIRE

    Meijer, A.J.

    2007-01-01

    Electronic records of government organizations are becoming increasingly important for accountability. Managing electronic records, however, proves to be difficult since information and communication technologies confront organizations with various opportunities and risks. In this paper the findings of an international expert survey on electronic records management are presented. These findings identify opportunities and risks for e-mail systems, database management systems, office systems, w...

  13. Manifesto on small airway involvement and management in asthma and chronic obstructive pulmonary disease: an Interasma (Global Asthma Association - GAA and World Allergy Organization (WAO document endorsed by Allergic Rhinitis and its Impact on Asthma (ARIA and Global Allergy and Asthma European Network (GA2LEN

    Directory of Open Access Journals (Sweden)

    F. Braido

    2016-10-01

    Full Text Available Abstract Evidence that enables us to identify, assess, and access the small airways in asthma and chronic obstructive pulmonary disease (COPD has led INTERASMA (Global Asthma Association and WAO to take a position on the role of the small airways in these diseases. Starting from an extensive literature review, both organizations developed, discussed, and approved the manifesto, which was subsequently approved and endorsed by the chairs of ARIA and GA2LEN. The manifesto describes the evidence gathered to date and defines and proposes issues on small airway involvement and management in asthma and COPD with the aim of challenging assumptions, fostering commitment, and bringing about change. The small airways (defined as those with an internal diameter <2 mm are involved in the pathogenesis of asthma and COPD and are the major determinant of airflow obstruction in these diseases. Various tests are available for the assessment of the small airways, and their results must be integrated to confirm a diagnosis of small airway dysfunction. In asthma and COPD, the small airways play a key role in attempts to achieve disease control and better outcomes. Small-particle inhaled formulations (defined as those that, owing to their size [usually <2 μm], ensure more extensive deposition in the lung periphery than large molecules have proved beneficial in patients with asthma and COPD, especially those in whom small airway involvement is predominant. Functional and biological tools capable of accurately assessing the lung periphery and more intensive use of currently available tools are necessary. In patients with suspected COPD or asthma, small airway involvement must be assessed using currently available tools. In patients with subotpimal disease control and/or functional or biological signs of disease activity, the role of small airway involvement should be assessed and treatment tailored. Therefore, the choice between large- and small-particle inhaled

  14. Know How to Use Your Asthma Inhaler

    Medline Plus

    Full Text Available ... Management Asthma Action Plan Flu Shots Inhalers Data, Statistics, and Surveillance Most Recent Asthma Data AsthmaStats Asthma- ... 4. Gathering and Using Data 4A. Focus On: Data Collection Choices 4B. Focus on Using Mixed Methods 5. ...

  15. Management of the patient with eosinophilic asthma: a new era begins

    Directory of Open Access Journals (Sweden)

    Jantina C. de Groot

    2015-09-01

    Full Text Available Now that it is generally accepted that asthma is a heterogeneous condition, phenotyping of asthma patients has become a mandatory part of the diagnostic workup of all patients who do not respond satisfactorily to standard therapy with inhaled corticosteroids. Late-onset eosinophilic asthma is currently one of the most well-defined asthma phenotypes and seems to have a different underlying pathobiology to classical childhood-onset, allergic asthma. Patients with this phenotype can be identified in the clinic by typical symptoms (few allergies and dyspnoea on exertion, typical lung function abnormalities (“fixed” airflow obstruction, reduced forced vital capacity and increased residual volume, typical comorbidities (nasal polyposis and a good response to systemic corticosteroids. The definitive diagnosis is based on evidence of eosinophilia in bronchial biopsies or induced sputum, which can be estimated with reasonable accuracy by eosinophilia in peripheral blood. Until recently, patients with eosinophilic asthma had a very poor quality of life and many suffered from frequent severe exacerbations or were dependent on oral corticosteroids. Now, for the first time, novel biologicals targeting the eosinophil have become available that have been shown to be able to provide full control of this type of refractory asthma, and to become a safe and efficacious substitute for oral corticosteroids.

  16. The dissemination of the British Guideline on the Management of Asthma 2003.

    Science.gov (United States)

    Dennis, S M; Edwards, S; Partridge, M R; Pinnock, H J; Qureshi, S J

    2004-09-01

    The BTS/SIGN British Guideline on the Management of Asthma was published in February 2003 (4). If health outcomes are to be influenced successfully, dissemination of the guideline and implementation of recommendations is essential. We report the dissemination activities undertaken during the 18 weeks following the guideline launch. To facilitate implementation a range of educational materials were produced reflecting the key messages from the guideline. In addition to postal mailing of the guideline to appropriate healthcare professionals, both educational materials and the guidelines were made freely available from the BTS and SIGN websites. In total, 135,710 copies of the guideline and 90,198 copies of the Quick Reference Guide were downloaded in the first 18 weeks, representing a considerable increase over the number of copies of the 1997 guidelines disseminated by mailing alone. Large quantities of educational materials were downloaded with many used for teaching purposes. An on-line survey suggested that most respondents rated the materials as useful or very useful. Using websites to disseminate guidelines is a cost-effective method of informing health professionals of their content and is a more active process than the passive receipt of mailed copies. The availability of interactive educational materials for use in teaching appears to have been popular.

  17. Pharmacogenomics of pediatric asthma

    Directory of Open Access Journals (Sweden)

    Gupta Sarika

    2010-01-01

    Full Text Available Context: Asthma is a complex disease with multiple genetic and environmental factors contributing to it. A component of this complexity is a highly variable response to pharmacological therapy. Pharmacogenomics is the study of the role of genetic determinants in the variable response to therapy. A number of examples of possible pharmacogenomic approaches that may prove of value in the management of asthma are discussed below. Evidence Acquisition: A search of PubMed, Google scholar, E-Medicine, BMJ and Mbase was done using the key words "pharmacogenomics of asthma", "pharmacogenomics of β-agonist, glucocorticoids, leukotriene modifiers, theophylline, muscarinic antagonists in asthma". Results: Presently, there are limited examples of gene polymorphism that can influence response to asthma therapy. Polymorphisms that alter response to asthma therapy include Arg16Gly, Gln27Glu, Thr164Ile for β-agonist receptor, polymorphism of glucocorticoid receptor gene, CRHR1 variants and polymorphism of LTC4S, ALOX5. Polymorphic variants of muscarinic receptors, PDE4 and CYP450 gene variants. Conclusion: It was concluded that genetic variation can improve the response to asthma therapy. However, no gene polymorphism has been associated with consistent results in different populations. Therefore, asthma pharmacogenomic studies in different populations with a large number of subjects are required to make possible tailoring the asthma therapy according to the genetic characteristic of individual patient.

  18. The efficacy of a comprehensive lifestyle modification programme based on yoga in the management of bronchial asthma: a randomized controlled trial

    OpenAIRE

    Bijlani Ramesh; Vempati Ramaprabhu; Deepak Kishore

    2009-01-01

    Abstract Background There is a substantial body of evidence on the efficacy of yoga in the management of bronchial asthma. Many studies have reported, as the effects of yoga on bronchial asthma, significant improvements in pulmonary functions, quality of life and reduction in airway hyper-reactivity, frequency of attacks and medication use. In addition, a few studies have attempted to understand the effects of yoga on exercise-induced bronchoconstriction (EIB) or exercise tolerance capacity. ...

  19. Reslizumab in the management of poorly controlled asthma: the data so far.

    Science.gov (United States)

    Maselli, Diego Jose; Velez, Maria Ines; Rogers, Linda

    2016-01-01

    Interleukin-5, an important cytokine in the pathophysiology of asthma, participates in terminal maturation and increases chemotaxis, endothelial adhesion, and activation of eosinophils. Blockade of interleukin-5 activity with monoclonal antibodies have been successful in decreasing eosinophil counts. Reslizumab, a monoclonal antibody that targets interleukin-5, has been studied for the treatment of severe asthma. Several studies have shown that reslizumab can effectively treat severe asthma with an eosinophilic phenotype. Compared to placebo, patients treated with reslizumab had a reduction in the rates of asthma exacerbations and experienced improvement in FEV1 and asthma control questionnaires scores as early as 4 weeks after the therapy was initiated. Reslizumab was not effective in various asthma outcomes in patients without eosinophilia. The adverse events reported were similar in both treatment and placebo groups. Patients should be observed immediately after treatment because anaphylaxis may occur rarely (0.3%) after exposure to reslizumab. Future surveillance studies are still needed to establish the risks of malignancy and safety during pregnancy. PMID:27621657

  20. Reslizumab in the management of poorly controlled asthma: the data so far

    Science.gov (United States)

    Maselli, Diego Jose; Velez, Maria Ines; Rogers, Linda

    2016-01-01

    Interleukin-5, an important cytokine in the pathophysiology of asthma, participates in terminal maturation and increases chemotaxis, endothelial adhesion, and activation of eosinophils. Blockade of interleukin-5 activity with monoclonal antibodies have been successful in decreasing eosinophil counts. Reslizumab, a monoclonal antibody that targets interleukin-5, has been studied for the treatment of severe asthma. Several studies have shown that reslizumab can effectively treat severe asthma with an eosinophilic phenotype. Compared to placebo, patients treated with reslizumab had a reduction in the rates of asthma exacerbations and experienced improvement in FEV1 and asthma control questionnaires scores as early as 4 weeks after the therapy was initiated. Reslizumab was not effective in various asthma outcomes in patients without eosinophilia. The adverse events reported were similar in both treatment and placebo groups. Patients should be observed immediately after treatment because anaphylaxis may occur rarely (0.3%) after exposure to reslizumab. Future surveillance studies are still needed to establish the risks of malignancy and safety during pregnancy.

  1. Korean Asthma Guideline 2014: Summary of Major Updates to the Korean Asthma Guideline 2014.

    Science.gov (United States)

    Kim, Deog Kyeom; Park, Yong Bum; Oh, Yeon-Mok; Jung, Ki-Suck; Yoo, Ji Hong; Yoo, Kwang-Ha; Kim, Kwan Hyung

    2016-07-01

    Asthma is a prevalent and serious health problem in Korea. Recently, the Korean Asthma Guideline has been updated by The Korean Academy of Tuberculosis and Respiratory Diseases (KATRD) in an effort to improve the clinical management of asthma. This guideline focuses on adult patients with asthma and aims to deliver up to date scientific evidence and recommendations to general physicians for the management of asthma. For this purpose, this guideline was updated following systematic review and meta-analysis of recent studies and adapting some points of international guidelines (Global Initiative for Asthma [GINA] report 2014, National Asthma Education and Prevention Program [NAEPP] 2007, British Thoracic Society [BTS/SIGN] asthma guideline 2012, and Canadian asthma guideline 2012). Updated issues include recommendations derived using the population, intervention, comparison, and outcomes (PICO) model, which produced 20 clinical questions on the management of asthma. It also covers a new definition of asthma, the importance of confirming various airflow limitations with spirometry, the epidemiology and the diagnostic flow of asthma in Korea, the importance and evidence for inhaled corticosteroids (ICS) and ICS/formoterol as a single maintenance and acute therapy in the stepwise management of asthma, assessment of severity of asthma and management of exacerbation, and an action plan to cope with exacerbation. This guideline includes clinical assessments, and treatment of asthma-chronic obstructive pulmonary disease overlap syndrome, management of asthma in specific conditions including severe asthma, elderly asthma, cough variant asthma, exercise-induced bronchial contraction, etc. The revised Korean Asthma Guideline is expected to be a useful resource in the management of asthma.

  2. Asthma control and management in 8,000 European patients : the REcognise Asthma and LInk to Symptoms and Experience (REALISE) survey

    NARCIS (Netherlands)

    Price, David; Fletcher, Monica; van der Molen, Thys

    2014-01-01

    BACKGROUND: Asthma is one of the most common chronic diseases in the world, and previous studies have reported low levels of control. Recent developments in the availability and use of online sources of information about asthma might add to patients' knowledge and help improve control. AIMS: To inve

  3. Predicting adult asthma in childhood

    NARCIS (Netherlands)

    Vonk, JM; Boezen, HM

    2006-01-01

    PURPOSE OF REVIEW: There still is no cure for asthma. Early identification of patients at risk for disease progression may lead to better treatment opportunities and hopefully better disease outcomes in adulthood. Recent literature on childhood risk factors associated with the outcome of asthma in a

  4. Evaluation of an Educational Program for Adolescents with Asthma

    Science.gov (United States)

    Berg, Jill; Tichacek, Mary J.; Theodorakis, Renee

    2004-01-01

    In addition to challenges of adolescence itself, teens with asthma face demands of asthma management and risks of asthma sequelae, including fatalities. Few asthma educational programs specifically address their needs. In response to school nurse concern, this pilot study evaluated an adolescent asthma education program, the "Power Breathing[TM]…

  5. Crisis Management: Challenge or Opportunity for Public and Private Managers Face Economic Disaster

    Directory of Open Access Journals (Sweden)

    Lucean MIHALCEA

    2012-11-01

    Full Text Available Successful managers find ways to overcome situations of uncertainty. The strategies adopted are based on a series of simplistic reasoning such as analogy, taking into account the ideas of experts, rigorous debate and experimentation. Napoleon Bonaparte said that "there is nothing more important and more valuable than being able to make decisions." Business leaders today must deal with an avalanche of ambiguity, it must decide on the future of the company. I intend to expose some successful methods by which top managers were able to transform into opportunities, challenges of economic crisis.

  6. New combination treatments in the management of asthma: focus on fluticasone/vilanterol

    Directory of Open Access Journals (Sweden)

    Tan LD

    2014-05-01

    Full Text Available Laren D Tan,1,2 Andrew L Chan,1,2 Timothy E Albertson1–3 1Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, School of Medicine, University of California, Davis, Sacramento, CA, 2Department of Medicine, Veterans Administration Northern California Health Care System, Mather, CA, 3Department of Emergency Medicine, School of Medicine, University of California, Davis, Sacramento, CA, USA Abstract: Despite the 2007 National Asthma Education and Prevention Program Expert Panel 3 guidelines for the treatment of uncontrolled asthma, many patients with poorly controlled asthma still continue to tax the health care system. Controlling asthma symptoms and preventing acute exacerbations have been the foundation of care. Using long-term controller treatments such as inhaled corticosteroids (ICS and inhaled long-acting beta2-agonists (LABAs is a common approach. While patient responses to recommended pharmacotherapy may vary, poor adherence to therapy also contributes to poor asthma control. A once-daily combination inhaler, such as fluticasone furoate, an ICS, in combination with vilanterol, a LABA, offers increased convenience and potential improved adherence, which should result in enhanced clinical outcomes and reduced exacerbations. The ICS/LABA combination inhaler of fluticasone furoate and vilanterol is currently approved in the United States for use in the maintenance of chronic obstructive pulmonary disease and to reduce exacerbations. This paper reviews the expanding literature on the efficacy of fluticasone furoate and vilanterol in treating asthma. Keywords: inhaled corticosteroids (ICS, long-acting beta2-agonist (LABA, asthma treatments

  7. Risk Assessment and Community Participation Model for Environmental Asthma Management in an Elementary Public School: A Case Study in Puerto Rico

    Directory of Open Access Journals (Sweden)

    Alberto Rivera-Rentas

    2006-03-01

    Full Text Available Asthma is a rapidly growing chronic disease in the general population of the world, mostly in children. Puerto Ricans have the highest prevalence of children with asthma among the Hispanic community in the US and its territories. Asthma and air quality are becoming a significant and potentially costly public health issue in Puerto Rico. The CDC has reported that in Puerto Rico, 320,350 adults have asthma and this number represents 11.5% of the island adult population. The north east municipality of Carolina, Puerto Rico, has the highest asthma prevalence in the 0 to 17 year old range (2001 data. In this study, we address the potential relationship between anthropogenic and naturally occurring environmental factors, and asthma prevalence in an urban elementary public school in Carolina in an effort to empower and engage communities to work on their environmental health issues. We integrated geographic information systems (GIS data of anthropogenic activities near the school as well as the natural resources and geomorphology of the region. We found that as Carolina is close by to Caribbean National Forest (El Yunque, this together with the temperature and precipitation cycles in the zone creates the ideal environmental conditions for increased humidity and pollen, mold and fungi development through out the year. We also collected health and socio economic data to generate an asthma profile of the students, employees and parents from the school community, and through a survey we identified perceptions on environmental asthma triggers, and indoor air quality in the school and homes of the students and employees. Finally, we implemented a workshop on indoor air quality designed to engage the school community in managing asthma triggers and the school environment. Our results showed that nearly 30 % of its student’s population has asthma, and from this group 58% are males and 42% are female students. Of all asthmatic children, only 43

  8. Managing Asthma in the School Environment: Indoor Air Quality Tools for Schools. EPA 402-K-10-004

    Science.gov (United States)

    US Environmental Protection Agency, 2010

    2010-01-01

    Asthma has reached epidemic proportions in the United States, affecting millions of people of all ages and races. An average of one out of every 10 school-age children now has asthma, and the percentage of children with asthma is rising more rapidly in preschool-age children than in any other age group. Asthma is a leading cause of school…

  9. The Relationship between Asthma and Obesity in Urban Early Adolescents

    OpenAIRE

    Jay, Melanie; Wijetunga, N Ari; Stepney, Cesalie; Dorsey, Karen; Chua, Danica Marie; Bruzzese, Jean-Marie

    2012-01-01

    Asthma and obesity, which have reached epidemic proportions, impact urban youth to a great extent. Findings are inconsistent regarding their relationship; no studies have considered asthma management. We explored the association of obesity and asthma-related morbidity, asthma-related health care utilization, and asthma management in urban adolescents with uncontrolled asthma. We classified 373 early adolescents (mean age=12.8 years; 82% Hispanic or Black) from New York City public middle scho...

  10. An analysis of the utilisation and expenditure of medicines dispensed for the management of severe asthma.

    LENUS (Irish Health Repository)

    McGowan, B

    2009-03-01

    There are approximately 6,300 people in Ireland with a diagnosis of Chronic Obstructive Pulmonary Disease (COPD) and with a fast growing elderly population the incidence of COPD is likely to increase. This study examines the prescribing patterns of medicines dispensed for the management Asthma\\/COPD in patients over the age of 35 years using the HSE-Primary Care Reimbursement Services (PCRS) prescribing databases. The HSE-PCRS pharmacy claims data, which covers all those over 70 years of age and means tested for those less than 70 years, was analysed for the years 2005\\/2006. Approximately 26,548 (17.9%) of patients who were prescribed a respiratory drug received inhaled short-acting beta2 agonists in combination with a regular standard-dose inhaled corticosteroid. A further 5,044 (3.4%) were also prescribed a regular inhaled long-acting beta2 agonist (salmeterol or formoterol). A total of 2506 patients (6.2%) on combination therapy were co-prescribed four different anti-asthmatic treatments inclusive of oral prednisolone. A small proportion of the patients prescribed a respiratory drug were co-prescribed nicotine replacement therapy (n = 5177, 3.5%). In total there were 9,728 (6.2%) patients prescribed a mucolytic drug in combination with a respiratory drug and the rate of co-prescribing with antibiotics was 22%. COPD is a debilitating disease that is primarily caused by smoking and is therefore largely preventable. The HSE-PCRS pharmacy claims data is a valuable tool for helping to assess the burden of this disease in the Irish context.

  11. How to manage project opportunity and risk why uncertainty management can be a much better approach than risk management

    CERN Document Server

    Ward, Stephen

    2011-01-01

    Since I wrote the Foreword for the second edition of this book, risk management processes have become much more widely used, but controversy about what should be done and how best to do it has grown. Managing risk is a risky business. Chapman and Ward provide an in-depth explanation of why it is important to understand and manage underlying uncertainty in all its forms, in order to realise opportunities more fully and enhance corporate performance. They show what best practice should look like. The implications go well beyond the conventional wisdom of project risk management, providing an enl

  12. Risk management in facility transition and management decision making: Needs and opportunities

    International Nuclear Information System (INIS)

    An overall approach to risk management is described in this paper. Many of these concepts have been developed and applied as part of Hanford Mission Planning (HMP) (Hanford Mission Plan, 1992). At Hanford, HMP provides a mechanism for integrating planning across all the missions and programs of the site. This paper discusses the decision context within which EM must make and defend decisions, the types of decisions that are being and will need to be made in order to progress with the cleanup of the DOE complex, and the resulting need for risk management. Risk management, in turn, requires quality health and ecological risk information to make these decisions. Other types of information are also needed, but the risk information is typically the most important and the most difficult to obtain. The paper then describes a general technical approach to risk management, including particular methods for developing the high quality of human health and ecological risk information that will be needed to support risk management. We next turn to several special issues that make risk management more complex than many other decisions. We discuss these issues and offer some practical suggestions with respect to addressing them in the risk management framework. Finally, we conclude with some discussion of other opportunities for applying risk management

  13. Risk management in facility transition and management decision making: Needs and opportunities

    Energy Technology Data Exchange (ETDEWEB)

    Stillwell, W.; Seaver, D.; Keller, J. [Pacific Northwest Lab., Richland, WA (United States); Smith, D. [USDOE, Washington, DC (United States); Weaver, D.; Sanders, T. [Sandia National Labs., Albuquerque, NM (United States); Thullen, P. [Los Alamos National Lab., NM (United States)

    1993-02-01

    An overall approach to risk management is described in this paper. Many of these concepts have been developed and applied as part of Hanford Mission Planning (HMP) (Hanford Mission Plan, 1992). At Hanford, HMP provides a mechanism for integrating planning across all the missions and programs of the site. This paper discusses the decision context within which EM must make and defend decisions, the types of decisions that are being and will need to be made in order to progress with the cleanup of the DOE complex, and the resulting need for risk management. Risk management, in turn, requires quality health and ecological risk information to make these decisions. Other types of information are also needed, but the risk information is typically the most important and the most difficult to obtain. The paper then describes a general technical approach to risk management, including particular methods for developing the high quality of human health and ecological risk information that will be needed to support risk management. We next turn to several special issues that make risk management more complex than many other decisions. We discuss these issues and offer some practical suggestions with respect to addressing them in the risk management framework. Finally, we conclude with some discussion of other opportunities for applying risk management.

  14. Evidence for the efficacy and safety of anti- interleukin-5 treatment in the management of refractory eosinophilic asthma

    OpenAIRE

    Xue, L.; Hilvering, B; Pavord, ID

    2015-01-01

    Two recent phase III trials in patients with severe eosinophilic asthma have shown that anti-interleukin 5 (IL-5) therapy with mepolizumab reduces the frequency of asthma attacks, improves symptoms and allows patients to reduce oral glucocorticoid use without loss of control of asthma. An earlier large 616 patient Dose Ranging Efficacy And safety with Mepolizumab in severe asthma (DREAM) study had shown that the only variables associated with treatment efficacy were a prior history of asthma ...

  15. MANAGEMENT OF INTERNAL RISKS AND OPPORTUNITIES OF ENTERPRISES

    OpenAIRE

    Yurij Vasilkov; Ludmila Gushina

    2015-01-01

    The work reviews the approach to the management of an organization taking into account internal risks caused by management decisions. Quantitative evaluations of individual risks, integrated risks, and the algorithm of the internal risks management are also reviewed.

  16. Clinical update on the use of biomarkers of airway inflammation in the management of asthma

    Directory of Open Access Journals (Sweden)

    Dorscheid DR

    2011-06-01

    Full Text Available SJ Wadsworth1,2, DD Sin1,2, DR Dorscheid1,21UBC James Hogg Research Centre, Providence Heart and Lung Institute, St Paul's Hospital, Vancouver, Canada; 2Department of Medicine, University of British Columbia, British Columbia, CanadaAbstract: Biological markers are already used in the diagnosis and treatment of cardiovascular disease and cancer. Biomarkers have great potential use in the clinic as a noninvasive means to make more accurate diagnoses, monitor disease progression, and create personalized treatment regimes. Asthma is a heterogeneous disease with several different phenotypes, generally triggered by multiple gene-environment interactions. Pulmonary function tests are most often used objectively to confirm the diagnosis. However, airflow obstruction can be variable and thus missed using spirometry. Furthermore, lung function measurements may not reflect the precise underlying pathological processes responsible for different phenotypes. Inhaled corticosteroids and ß2-agonists have been the mainstay of asthma therapy for over 30 years, but the heterogeneity of the disease means not all asthmatics respond to the same treatment. High costs and undesired side effects of drugs also drive the need for better targeted treatment of asthma. Biomarkers have the potential to indicate an individual's disease phenotype and thereby guide clinicians in their decisions regarding treatment. This review focuses on biomarkers of airway inflammation which may help us to identify, monitor, and guide treatment of asthmatics. We discuss biomarkers obtained from multiple physiological sources, including sputum, exhaled gases, exhaled breath condensate, serum, and urine. We discuss the inherent limitations and benefits of using biomarkers in a heterogeneous disease such as asthma. We also discuss how we may modify our study designs to improve the identification and potential use of potential biomarkers in asthma.Keywords: asthma, inflammation, airway

  17. The use of inhaled mannitol in the diagnosis and management of asthma

    DEFF Research Database (Denmark)

    Sverrild, Asger; Porsbjerg, Celeste; Backer, Vibeke

    2012-01-01

    for the diagnosis of asthma in both children and adults. Discomfort, in terms of cough, during the test occurs in 85.3% of subjects, but rarely (1.3%) leads to discontinuation. Headache (6.1%), pharyngolaryngeal pain (2.6%) and cough (1.3%) are the most frequent adverse events that occur on the day of the test...

  18. Global strategy for the diagnosis and management of asthma in children 5 years and younger

    DEFF Research Database (Denmark)

    Hurd, Suzanne S; Lemanske, Robert F; Becker, Allan;

    2011-01-01

    Asthma is the most common chronic disease of childhood and the leading cause of childhood morbidity from chronic disease as measured by school absences, emergency department visits, and hospitalisation. During the past two decades, many scientific advances have improved our understanding of asthm...

  19. Improvement in symptoms and pulmonary function of asthmatic patients due to their treatment according to the Global Strategy for Asthma Management (GINA

    Directory of Open Access Journals (Sweden)

    Rahimi Najmah

    2008-12-01

    Full Text Available Abstract Background Global Initiative Strategy for Asthma Management (GINA is poorly applied in undeveloped and developing countries. The current study examined the effects of applying GINA guidelines on treatment efficacy in asthmatic patients in Iran. Methods Twenty four asthmatic patients (usual care group were treated as usual and 26 patients (intervention group according to the GINA for 2 months. Asthma symptom score, asthma severity, frequency of symptoms/week and wheezing were recorded at the beginning (first visit, one month after treatment (second visit, and at the end of the study (third visit. Pulmonary function tests (PFTs were performed by spirometry, and the patients' use of asthma drugs and their symptoms were evaluated, at each visit. Results Asthma symptoms, frequency of symptoms/week, chest wheezing, and PFT values were significantly improved in the intervention group at the second and third visits compared to first visit (p Conclusion Adoption of GINA guidelines improves asthma symptoms and pulmonary function in asthmatic patients in Iran.

  20. Adherence to asthma guidelines in general practices.

    Science.gov (United States)

    Roghmann, M C; Sexton, M

    1999-06-01

    Adherence to asthma practice guidelines is low. Improved compliance could potentially improve care of patients with asthma. The purpose of this study was to determine if patients managed in a general practice with an associated asthma clinic are more likely to use asthma medications according to clinical practice guidelines than patients managed in the general surgery of the practice. A cross-sectional study of adult asthmatics, aged 18-55 years, was conducted in six British general practices. Prescription data on all asthma medication was collected for a 6-month period. Information on asthma clinic attendance, age, sex, employment status, other medical illness, and how patients used their inhaled beta2-agonist was collected through questionnaire. The prescription data for asthma medication and patient use of inhaled beta2-agonist were compared to the British Thoracic Society's (BTS) Guidelines for Management of Asthma in Adults to determine if the patient's asthma medication regimen was appropriate. There was no significant association found between appropriate asthma medication and asthma clinic attendance or other patient characteristics. Adherence to the BTS guidelines was low. Fifty-eight percent of the asthma patients used asthma medication regimens that were not consistent with the BTS guidelines published 1 year earlier. Adherence to the BTS guidelines was low regardless of patient characteristics, including asthma clinic attendance, age, sex, employment status, other medical illness, or individual practice. These findings underscore the need to document the utility of clinical practice guidelines which may improve physician compliance.

  1. Effectiveness of inhaler types for real-world asthma management: retrospective observational study using the GPRD

    Directory of Open Access Journals (Sweden)

    Price D

    2011-04-01

    Full Text Available David Price1,2 John Haughney1, Erika Sims2, Muzammil Ali2, Julie von Ziegenweidt2, Elizabeth V Hillyer2, Amanda J Lee3, Alison Chisholm2, Neil Barnes41Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK; 2Research in Real Life Ltd, Cawston, Norwich, UK; 3Section of Population Health, University of Aberdeen, UK; 4Department of Respiratory Medicine, London Chest Hospital, Barts and The London NHS Trust, London, UKPurpose: Results of randomized controlled trials may not predict effectiveness of inhaled corticosteroids (ICS in real-world clinical practice, where inhaler technique and device characteristics can influence effectiveness. We compared asthma outcomes for ICS delivered via three different inhaler devices: pressurized metered-dose inhaler (pMDI, breath-actuated MDI (BAI, and dry powder inhaler (DPI.Patients and methods: This retrospective database study evaluated 1-year outcomes for primary care patients with asthma aged 5–60 years prescribed their first ICS (initiation population by pMDI (n = 39,746, BAI (n = 9809, or DPI (n = 6792, or their first ICS dose increase (step-up population by pMDI (n = 6245, BAI (n = 1388, or DPI (n = 1536. Co-primary outcome measures were composite proxy measures of asthma control (no hospital attendance for asthma, oral corticosteroids, or antibiotics for lower respiratory infection and severe exacerbations (unscheduled hospital admission, emergency room attendance, or oral corticosteroids. Outcomes were adjusted for potential confounding factors identified during a baseline year.Results: In the initiation population, adjusted odds ratios (95% confidence intervals [CI] for asthma control, as compared with pMDIs, were significantly better for BAIs (1.08 [1.02–1.14] and DPIs (1.13 [1.06–1.21], while adjusted exacerbation rate ratios (95% CI were 1.00 (0.93–1.08 and 0.88 (0.81–0.95, respectively. In the step-up population, adjusted odds of asthma control were 1.21 (1.05–1.39 for

  2. Remote monitoring of inhaled bronchodilator use and weekly feedback about asthma management: an open-group, short-term pilot study of the impact on asthma control.

    Directory of Open Access Journals (Sweden)

    David Van Sickle

    Full Text Available OBJECTIVE: Adequate symptom control is a problem for many people with asthma. We asked whether weekly email reports on monitored use of inhaled, short-acting bronchodilators might improve scores on composite asthma-control measures. METHODS: Through an investigational electronic medication sensor attached to each participant's inhaler, we monitored 4 months' use of inhaled, short-acting bronchodilators. Participants completed surveys, including the Asthma Control Test(TM (ACT, to assess asthma control at entry and monthly thereafter. After the first month, participants received weekly email reports for 3 months. The reports summarized inhaled bronchodilator use during the preceding week and provided suggestions derived from National Asthma Education and Prevention Program (NAEPP guidelines. Paired t-tests and random-effects mixed models were implemented to assess changes in primary asthma endpoints. RESULTS: Thirty individuals participated in the 4-month study; 29 provided complete asthma control information. Mean age was 36.8 years (range: 19-74 years; 52% of respondents were female. Mean ACT scores were 17.6 (Standard Deviation [SD]  = 3.35 at entry and 18.4 (SD = 3.60 at completion of the first month. No significant difference appeared between ACT values at entry and completion of the first month (p = 0.66; however, after participants began receiving email reports and online information about their inhaler use, mean ACT scores increased 1.40 points (95% CI: 0.61, 2.18 for each subsequent study month. Significant decreases occurred in 2-week histories of daytime symptoms (β = -1.35, 95% CI: -2.65, -0.04 and nighttime symptoms (β = -0.84, 95% CI: -1.25, -0.44; no significant change in activity limitation (β = -0.21, 95% CI: -0.69, 0.26 was observed. Participants reported increased awareness and understanding of asthma patterns, level of control, bronchodilator use (timing, location and triggers, and improved

  3. University management-improvements and dilemma in the of equal opportunities

    OpenAIRE

    Ph. d.PROFESSOR iORDACHE PLAT

    2011-01-01

    Equal opportunity is a relatively new concept which first of all must be understood, and then implemented as a premise and note as a result of current activities. Equal opportunity in organizations is a new way of achieving results and the modern management puts it as a necessary principle among old ones, such as benchmarking, corporate governance, customer relatioship marketing, experience curve, strategies alliances etc. This paper explains the equal opportunity in higher education institut...

  4. Structured discharge procedure for children admitted to hospital with acute asthma: a randomised controlled trial of nursing practice

    OpenAIRE

    Wesseldine, L; McCarthy, P.; Silverman, M

    1999-01-01

    BACKGROUND—Discharge planning is becoming an important part of the management of childhood asthma in hospital. Readmission to hospital, although often inevitable, might represent a failure of the opportunity for intervention presented by a brief period of supervised care in hospital.
AIM—To examine the impact of a structured, nurse-led discharge package for children admitted to hospital with acute asthma on readmission to hospital, reattendance at the accident and emergen...

  5. Pharmacotherapy of severe asthma

    OpenAIRE

    Firszt, Rafael; Kraft, Monica

    2010-01-01

    Severe asthma is a complex and heterogeneous phenotype where management can be challenging. While many patients with severe asthma respond to high-dose inhaled corticosteroids in combination with a long-acting β-agonist, there remains a significant subset of patients that require oral corticosteroids to control symptoms. Alternative therapies are needed to help reduce the need for continuous oral corticosteroids; however, there are currently very few effective options. Several new alternative...

  6. Relvar Ellipta for asthma.

    Science.gov (United States)

    2014-08-01

    ▼Relvar Ellipta (GSK) is a dry powder inhaler that contains a corticosteroid (fluticasone furoate) and a long-acting beta2 agonist (vilanterol trifenatate). It is licensed for once-daily use as maintenance therapy for chronic obstructive pulmonary disease (COPD) and asthma. In a previous article we considered its use in the management of COPD.1 Here we review the evidence for Relvar Ellipta in the treatment of patients with asthma.

  7. 78 FR 34323 - Funding Opportunity Title: Risk Management Education in Targeted States (Targeted States Program)

    Science.gov (United States)

    2013-06-07

    ... Federal Crop Insurance Corporation Funding Opportunity Title: Risk Management Education in Targeted States... ] communities, and providing risk management education and information. One of RMA's strategic goals is to... emphasis on risk management strategies and crop insurance education specifically targeted to the...

  8. Forest Service Career Guide. Professional Opportunities in Natural Resource Management, Planning, and Research. Revised Edition.

    Science.gov (United States)

    Forest Service (USDA), Washington, DC.

    The guide provides information on professional opportunities in natural resource management, planning, and research. Reasons for careers in forest service are presented and a brief description of the forest service is provided. Career opportunities in the following areas are described: forestry, engineering, geology, hydrology, landscape…

  9. Internet-based self-management support for adults with asthma: a qualitative study among patients, general practitioners and practice nurses on barriers to implementation

    Science.gov (United States)

    van Gaalen, Johanna L; van Bodegom-Vos, Leti; Bakker, Moira J; Snoeck-Stroband, Jiska B; Sont, Jacob K

    2016-01-01

    Objectives The aim of this study was to explore barriers among patients, general practitioners (GPs) and practice nurses to implement internet-based self-management support as provided by PatientCoach for asthma in primary care. Setting Primary care within South Holland, the Netherlands. Participants Twenty-two patients (12 women, mean age 38 years), 21 GPs (6 women, mean age 52 years) and 13 practice nurses (all women, mean age 41 years). Design A qualitative study using focus groups and interviews. Outcomes Barriers as perceived by patients, GPs and practice nurses to implementation of PatientCoach. Methods 10 focus groups and 12 interviews were held to collect data: 4 patient focus groups, 4 GP focus groups, 2 practice nurse focus group, 2 patient interviews, 5 GP interviews and 5 practice nurse interviews. A prototype of PatientCoach that included modules for coaching, personalised information, asthma self-monitoring, medication treatment plan, feedback, e-consultations and a forum was demonstrated. A semistructured topic guide was used. Directed content analysis was used to analyse data. Reported barriers were classified according to a framework by Grol and Wensing. Results A variety of barriers emerged among all participant groups. Barriers identified among patients include a lack of a patient–professional partnership in using PatientCoach and a lack of perceived benefit in improving asthma symptoms. Barriers identified among GPs include a low sense of urgency towards asthma care and current work routines. Practice nurses identified a low level of structured asthma care and a lack of support by colleagues as barriers. Among all participant groups, insufficient ease of use of PatientCoach, lack of financial arrangements and patient characteristics such as a lack of asthma symptoms were reported as barriers. Conclusions We identified a variety of barriers to implementation of PatientCoach. An effective implementation strategy for internet-based self-management

  10. Validation of the Arabic version of the asthma control test

    OpenAIRE

    Lababidi H; Hijaoui A; Zarzour M

    2008-01-01

    Purpose: Asthma control test (ACT) has been devised to assess the degree of asthma control in out-patients setting. The aim of this study is to validate the Arabic version of ACT. Materials and Methods: Patients completed the Arabic version of ACT during regular visit to one of two asthma specialists. Spirometry was obtained. The asthma specialist rated asthma control using a 5-point scale and indicated modification in management as step up, same or step down of asthma treatment. Results:...

  11. PILL Series. The ‘problematic’ asthma patient

    OpenAIRE

    Kui, Swee Leng; How, Choon How; Koh, Jansen

    2015-01-01

    Asthma is a reversible chronic inflammatory disorder of the airways that can be effectively controlled without causing any lifestyle limitation or burden on the quality of life of the majority of asthma patients. However, persistently uncontrolled asthma can be frustrating for both the patient and the managing physician. Patients who fail to respond to high-intensity asthma treatment fall into the category of ‘problematic’ asthma, which is further subdivided into ‘difficult’ asthma and ‘sever...

  12. Accountability in an information age : opportunities and risks for records management

    NARCIS (Netherlands)

    Meijer, A.J.

    2007-01-01

    Electronic records of government organizations are becoming increasingly important for accountability. Managing electronic records, however, proves to be difficult since information and communication technologies confront organizations with various opportunities and risks. In this paper the findings

  13. University management-improvements and dilemma in the of equal opportunities

    Directory of Open Access Journals (Sweden)

    Ph. d.PROFESSOR iORDACHE PLAT

    2011-12-01

    Full Text Available Equal opportunity is a relatively new concept which first of all must be understood, and then implemented as a premise and note as a result of current activities. Equal opportunity in organizations is a new way of achieving results and the modern management puts it as a necessary principle among old ones, such as benchmarking, corporate governance, customer relatioship marketing, experience curve, strategies alliances etc. This paper explains the equal opportunity in higher education institutions, their improvements and dilemma sin implementing equal opportunities.

  14. Nasal polyps in patients with asthma: prevalence, impact, and management challenges

    OpenAIRE

    Mullol, Joaquim

    2016-01-01

    Cristobal Langdon,1,2 Joaquim Mullol1–3 1Rhinology Unit and Smell Clinic, Otorhinolaryngology Department, Hospital Clínic, 2Clinical and Experimental Respiratory Immunoallergy (IRCE), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 3Centre for Biomedical Research in Respiratory Diseases (CIBERES), Barcelona, Catalonia, SpainAbstract: Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) often have coexisting asthma under th...

  15. Nasal polyps in patients with asthma: prevalence, impact, and management challenges

    OpenAIRE

    Langdon C; Mullol J

    2016-01-01

    Cristobal Langdon,1,2 Joaquim Mullol1–3 1Rhinology Unit and Smell Clinic, Otorhinolaryngology Department, Hospital Clínic, 2Clinical and Experimental Respiratory Immunoallergy (IRCE), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 3Centre for Biomedical Research in Respiratory Diseases (CIBERES), Barcelona, Catalonia, SpainAbstract: Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) often have coexisting asthma under the concept of &ld...

  16. 310 Diagnosis and Management of Post-radiation Pneumonitis in Patients with Asthma

    OpenAIRE

    Syrigou, Ekaterini; Ralli, Maria; Psarros, Fotis; Makrilia, Nektaria; Charpidou, Andriani; Dannos, Ioannis; Kostas N. Syrigos

    2012-01-01

    Background Lung cancer remains the leading cause of cancer-related deaths among men and women in the civilized world. A notable number of patients undergo radiation in various stages of the treatment process and its main respiratory side effect is pneumonitis. Our aim was to investigate the diagnostic and treatment methods of post-radiation pneumonitis particularly in asthma patients. Methods A literature search was performed in Pubmed to identify relative studies published until June 2011. L...

  17. Patient perspectives in the management of asthma: improving patient outcomes through critical selection of treatment options

    OpenAIRE

    Nicola Scichilone; Adele Contino; Giovanni Battista Figlioli; et al

    2010-01-01

    Nicola Scichilone, Adele Contino, Giovanni Battista Figlioli, Giuseppe Paglino, Vincenzo BelliaDipartimento di Medicina, Pneumologia, Fisiologia e Nutrizione Umana (DIMPEFINU), University of Palermo, Palermo, ItalyAbstract: Asthma is a chronic inflammatory disorder of the airways that requires long-term treatment, the goal of which is to control clinical symptoms for extended periods with the least possible amount of drugs. International guidelines recommend the addition of an inhaled long-ac...

  18. Getting control of uncontrolled asthma.

    Science.gov (United States)

    Wechsler, Michael E

    2014-11-01

    Despite various treatment modalities, a large proportion of patients have asthma that remains uncontrolled. These patients remain at an increased risk of developing severe exacerbations, have a poor quality of life, and pose a high economic healthcare burden, with an estimated mean annual cost more than double that of patients with good symptom control. It is therefore important to accurately diagnose asthma and continually assess asthma control. Several validated tools are available to do this, including questionnaires, biomarker analysis, and bronchoscopy. Current guidelines advise physicians to establish a self-management program for the patient to assess and monitor asthma control. A further recommendation is the establishment of an educational action plan to increase treatment adherence and to improve asthma control. National and international guidelines provide long-term management strategies for these patients and recommend a stepwise approach for achieving and maintaining asthma control. Despite availability of a wide range of controller and reliever therapies, uncontrolled asthma remains a challenge and reflects the need for new therapeutic options. This review discusses current global guidelines for the assessment and management of asthma control and summarizes the broad spectrum of novel therapeutic agents currently under development for the treatment of asthma, including anticholinergics, chemoattractant receptor-homologous molecules expressed on T-helper 2 lymphocyte antagonists, and anti-interleukin (IL)-5, anti-IL-13, and anti-IL-4 agents. PMID:24844737

  19. Evidence for the efficacy and safety of anti-interleukin-5 treatment in the management of refractory eosinophilic asthma

    NARCIS (Netherlands)

    Hilvering, Bart; Xue, Luzheng; Pavord, Ian D

    2015-01-01

    Two recent phase III trials in patients with severe eosinophilic asthma have shown that anti-interleukin 5 (IL-5) therapy with mepolizumab reduces the frequency of asthma attacks, improves symptoms and allows patients to reduce oral glucocorticoid use without loss of control of asthma. An earlier la

  20. Pediatric Interstitial Lung Disease Masquerading as Difficult Asthma: Management Dilemmas for Rare Lung Disease in Children

    Directory of Open Access Journals (Sweden)

    EY Chan

    2005-01-01

    Full Text Available Idiopathic nontransplant-related childhood bronchiolitis obliterans is an uncommon disease. Most patients present with chronic recurrent dyspnea, cough and wheezing, which are also features of asthma, by far a much more common condition. The present case study reports on a six-year-old girl who presented to a tertiary care centre with recurrent episodes of respiratory distress on a background of baseline tachypnea, chronic hypoxemia and exertional dyspnea. Her past medical history revealed significant lung disease in infancy, including respiratory syncytial virus bronchiolitis and repaired gastroesophageal reflux. She was treated for 'asthma exacerbations' throughout her early childhood years. Bronchiolitis obliterans was subsequently diagnosed with an open lung biopsy. She did not have sustained improvement with systemic corticosteroids, hydroxychloroquine or clarithromycin. Cardiac catheterization confirmed the presence of secondary pulmonary hypertension. Treatment options remain a dilemma for this patient because there is no known effective treatment for this condition, and the natural history is not well understood. The present case demonstrates the need for careful workup in 'atypical asthma', and the urgent need for further research into the rare lung diseases of childhood.

  1. Patient perspectives in the management of asthma: improving patient outcomes through critical selection of treatment options

    Directory of Open Access Journals (Sweden)

    Nicola Scichilone

    2010-02-01

    Full Text Available Nicola Scichilone, Adele Contino, Giovanni Battista Figlioli, Giuseppe Paglino, Vincenzo BelliaDipartimento di Medicina, Pneumologia, Fisiologia e Nutrizione Umana (DIMPEFINU, University of Palermo, Palermo, ItalyAbstract: Asthma is a chronic inflammatory disorder of the airways that requires long-term treatment, the goal of which is to control clinical symptoms for extended periods with the least possible amount of drugs. International guidelines recommend the addition of an inhaled long-acting beta2-agonist (LABA to a low- to medium-dose inhaled corticosteroid (ICS when low doses of ICS fail to control asthma symptoms. The fixed combined administration of ICS/LABA improves patient compliance, reducing the risk of therapy discontinuation. The relative deposition pattern of the inhaled drug to the target site is the result of a complex interaction between the device used, the aerosol formulation and the patient’s adherence to therapy. Different inhalation devices have been introduced in clinical practice over time. The new hydrofluoroalkane (HFA solution aerosols allow for the particle size to be modified, thus leading to deeper penetration of the medication into the lung. The Modulite® technology allows for the manipulation of inhaled HFA-based solution formulations, such as the fixed beclomethasone/formoterol combination, resulting in a uniform treatment of inflammation and bronchoconstriction. The success of any anti-asthmatic treatment depends on the choice of the correct device and the adherence to therapy.Keywords: asthma, therapy, inhalers, compliance

  2. Interpreting Financial Results. Financial Management Module. Operational Management Programme. Increasing Opportunities for Supervisors and Managers.

    Science.gov (United States)

    Adamson, Jan; And Others

    One of a series of three self-instructional units, these materials are aimed at helping British hotel and catering managers improve profits and/or reduce costs in their areas of responsibility. Following an introduction and a paragraph on how to use the unit, section 1 covers how to use management information. The section includes these trainee…

  3. Partnerships and opportunities: The archival management of geographic information systems

    Science.gov (United States)

    Zimmerman, Ann

    1995-01-01

    This article provides an overview of geographic information systems (GISs) technology and applications. It discusses its implications for archives, including a review of the existing literature. Finally, the article recommends a strategy for managing such systems based on the study of an environmental GIS application in a federal research center and on the vision recently expressed by David Bearman and Margaret Hedstrom. A multi-staged approach to the archival management of GISs is recommended and new partnerships are suggested to aid archivists in the future management of these systems.

  4. Utility Management in the 21st Century: Challenges and Opportunities.

    Science.gov (United States)

    Schubbe, Thomas L.

    1999-01-01

    Provides an overview of the factors that must be examined and the issues to be addressed when assessing an institution's utility systems. Describes the management, planning, financing, and political dynamics surrounding the ownership of an institution's energy facilities. (GR)

  5. Fiscal Management in the Academic Library: Challenge and Opportunity.

    Science.gov (United States)

    Simmons, Beatrice

    1979-01-01

    Suggests that academic library management, working cooperatively with operational staff, re-think service pedagogies and staffing configurations, involve librarians in the instructional process, develop relationships with faculty and students, and improve collection development in periods of fiscal retrenchment. (FM)

  6. Supply Chain Management: Implementation Issues and Research Opportunities

    DEFF Research Database (Denmark)

    Pagh, Janus Dóre; Cooper, Martha

    1998-01-01

    This paper concentrates on operationalizing the supply chain management framework suggested in a 1997 article. Case studies conducted at several companies and involving multiple members of supply chains are used to illustrate the concepts described......This paper concentrates on operationalizing the supply chain management framework suggested in a 1997 article. Case studies conducted at several companies and involving multiple members of supply chains are used to illustrate the concepts described...

  7. A Theoretical Framework for Operational Risk Management and Opportunity Realisation

    OpenAIRE

    Adrian Sparrow

    2000-01-01

    Advanced probability models are used to evaluate risks and to justify decisions where reliable data is available, e.g. reinsurance, money markets and nuclear energy. Operational risk management – the trade-offs made to run an efficient and effective organisation – has much less, and lower quality, data. In the first part of the paper, observations are made about the factors shaping operational risk management: the increasing shift of influence from tangible to intangible variables; the intuit...

  8. Managment in the global economy: opportunities and risks

    OpenAIRE

    Neterda, Filip Bc.

    2008-01-01

    The thesis start from general introduction to globalization but its focus is on the following areas: global buying of company inputs (sourcing), expanding on the foreign/global markets (output) and managing the risks associated with globalization (increased competition, foreign currency and raw material/inputs hedge). Overall the thesis is practical in its approach and thus it provides the real applicable approaches in terms of the management in the global economy. Despite these practicalitie...

  9. Developing Meaningful and Manageable Research Opportunities for Community College Students

    Science.gov (United States)

    Boryta, M. D.; Walker, B.; Cano, E.; Chi, B.; De Martinez, L.; Diaz, M.; Eckert, S.; Hoffman, A.; Lee, T.

    2012-12-01

    Independent research experience opportunities are bountiful for juniors and seniors at 4-year institutions, but far fewer opportunities exist for community college geoscience students. At Mt. San Antonio College (a community college in Los Angeles County), we sometimes offer an independent study course to 1 or 2 exceptional students. In the Spring 2012 semester our goal, for a few qualified students, was to extend their understanding (beyond what they had learned in Physical Geology) of some of the techniques, tools, and ways of thinking used by professional geoscientists, in an effort to better prepare them to transfer to 4-year institutions as geoscience majors. However, when 7 students became excited to participate, we quickly expanded the goals to include giving students the responsibility of defining the project's scope and procedures, introducing them to collaborative and ongoing research, and growing the scope of the project over several semesters. The project involved a preliminary assessment of a tributary in the San Juan Creek watershed in Orange County; techniques included stream and beach profiling, bedrock geology mapping, and sediment sampling and analysis. In addition to presenting preliminary results, we will report on lessons learned about necessary course elements, the importance of establishing academic and personal conduct expectations for students, and methods of assessing student work in a lower-division research experience. We will also discuss several barriers that were encountered during the first semester of the project, including involving faculty, students, and resources as well as strategies that we are currently employing to address these challenges.

  10. Intravenous magnesium for acute asthma?

    Science.gov (United States)

    2003-10-01

    Each year in the UK, around 1,500 people die from asthma. Standard treatment has been based on bronchodilators (e.g. beta 2-stimulants) and anti-inflammatory drugs (corticosteroids). The recently revised British Guideline on the Management of Asthma suggests also using a single dose of i.v. magnesium sulphate in patients with acute severe asthma, an unlicensed indication. Here we discuss the rationale for giving i.v. magnesium and whether it offers any advantage for patients with acute severe asthma.

  11. Obesity-related asthma in adults.

    Science.gov (United States)

    Bhatt, Nikunj A; Lazarus, Angeline

    2016-08-01

    Obesity as a risk factor for asthma has been identified in previous studies. Additionally, a disproportionate number of patients with severe or difficult-to-control asthma are obese. Patients with obesity-related asthma tend to have worse asthma control and quality of life disproportionate to their pulmonary function tests, are less responsive to corticosteroid therapy, and are more likely to have obesity-related comorbidities such as obstructive sleep apnea and gastroesophageal disease that complicate asthma treatment. With the increasing prevalence of obesity, the prevalence of asthma is anticipated to grow proportionally. Addressing weight loss and encouraging activity is essential in the management of obesity-related asthma. This article briefly overviews the epidemiology, unique distinguishing features, potential mechanisms, and approach to management of patients with obesity-related asthma in adults. PMID:27336439

  12. Near-fatal asthma in the elderly.

    Science.gov (United States)

    Arjona, Nydia

    2015-01-01

    Asthma affects the elderly as often as other age groups; however, it more often becomes fatal in the elderly. Unfortunately, asthma is often unmanaged or underdiagnosed in the older population. It is important for health care providers to recognize risk factors in the elderly and properly treat them before asthma becomes fatal. This article describes near-fatal asthma and identifies risk factors specifically for the elderly. Symptoms of asthma are reviewed as well as assessments and diagnostic tests to identify asthma severity and complications. Proper management needs to be urgently initiated to prevent worsening respiratory distress; this includes fast-acting drug treatments appropriate for elderly patients. Decompensated acute respiratory failure, secondary to severe asthma, requires the skills of an experienced anesthesiologist because these patients may rapidly deteriorate during induction and intubation. Ventilator management must include strategies to prevent worsening hyperinflation of the lungs. Elderly asthma patients have a higher mortality risk related to ventilator complications and other comorbidities. PMID:25470264

  13. Managing Intellectual Property in the Defense Establishment: Opportunities and Risks

    Directory of Open Access Journals (Sweden)

    Shmuel Even

    2014-12-01

    Full Text Available In Israel, there is a consensus on the value of all knowledge generated in the defense establishment and its contribution to the economy. But in the State Comptroller’s report of March 2014, the management of intellectual property (IP at the Ministry of Defense was described as an ongoing fiasco, with the blame ascribed to both the Ministry of Defense and the Ministry of Finance. This essay seeks to contribute to the discourse on remedying the flaws and suggest some organizing principles in the management of IP, while considering both the needs of the defense establishment and those of the Israeli economy. The essay proposes that the IDF manage the IP under its purview as part of the organization’s knowledge management, but not engage in financial IP transactions; a specially designated company should be established in the Ministry of Defense that would be responsible for this. At present, the chances of such a move succeeding seem low, but even if it results only in an improvement of the management of technological knowledge in the defense establishment, it would constitute an achievement. Knowing that the idea of commercializing knowledge has been seriously and thoroughly examined is important in and of itself.

  14. Asthma: Not Just a Childhood Condition.

    Science.gov (United States)

    Strauss, Kandra

    2002-01-01

    Asthma has grown to epidemic proportions among school-age children, and nearly 10 million U.S. adults suffer from it. This paper describes asthma and its triggers and explains how to take measures to manage asthma symptoms within the school (e.g., dusting regularly and keeping medications available). A sidebar presents tips on controlling asthma…

  15. Children with Asthma: Strategies for Educators.

    Science.gov (United States)

    Neuharth-Pritchett, Stacey; Getch, Yvette Q.

    1999-01-01

    Guidelines for managing the child with asthma in educational settings address effects of asthma on academic performance, psychosocial effects, the need for collaboration with parents and medical personnel, common triggers of asthmatic episodes, symptoms, communication with parents, and resources. A sample asthma care plan is attached. (DB)

  16. Japanese Guideline for Adult Asthma 2014

    Directory of Open Access Journals (Sweden)

    Ken Ohta

    2014-01-01

    Full Text Available Adult bronchial asthma (hereinafter, asthma is characterized by chronic airway inflammation, reversible airway narrowing, and airway hyperresponsiveness. Long-standing asthma induces airway remodeling to cause intractable asthma. The number of patients with asthma has increased, and that of patients who die from asthma has decreased (1.5 per 100,000 patients in 2012. The aim of asthma treatment is to enable patients with asthma to lead a normal life without any symptoms. A good relationship between physicians and patients is indispensable for appropriate treatment. Long-term management with antiasthmatic agents and elimination of the causes and risk factors of asthma are fundamental to its treatment. Four steps in pharmacotherapy differentiate between mild and intensive treatments; each step includes an appropriate daily dose of an inhaled corticosteroid, varying from low to high. Long-acting 02-agonists, leukotriene receptor antagonists, and sustained-release theophylline are recommended as concomitant drugs, while anti-immunoglobulin E antibody therapy has been recently developed for the most severe and persistent asthma involving allergic reactions. Inhaled 02-agonists, aminophylline, corticosteroids, adrenaline, oxygen therapy, and others are used as needed in acute exacerbations by choosing treatment steps for asthma exacerbations depending on the severity of attacks. Allergic rhinitis, chronic obstructive pulmonary disease, aspirin-induced asthma, pregnancy, asthma in athletes, and coughvariant asthma are also important issues that need to be considered.

  17. Challenges and opportunities for managing respiratory disease in dairy calves.

    Science.gov (United States)

    Stanton, Amy

    2009-12-01

    Bovine respiratory disease (BRD) is important for the Ontario dairy industry due to the large economic and welfare costs of this disease. Practical science-based management techniques are needed to control and reduce the risk of this disease. Currently, the emphasis on BRD is focused on early detection of disease and prevention. These areas are important but it is not practical to assume this disease will be eliminated in the near future. It is necessary to determine the best practices for caring for sick animals, monitoring their recovery and making changes to their management to facilitate health and recovery. If management changes can be made for animals that are failing to thrive in a current situation, a more complete recovery may be possible and the welfare and economic costs of BRD may be minimized. PMID:20003645

  18. Leveraging Enterprise Risk Management: Opportunity for Greater Relevance

    Science.gov (United States)

    Abraham, Janice M.; Baird, Robert; Neugebauer, Frank

    2013-01-01

    Enterprise Risk Management (ERM) gained a foothold in higher education during the first decade of the 21st century. College and university governing board members came to their board service with the perspective and experience of having served on corporate boards and in corporate leadership positions where ERM was in active use. Trustees asked…

  19. Omalizumab in the management of patients with allergic (IgE-mediated) asthma

    OpenAIRE

    Thomas Sandström

    2009-01-01

    Thomas SandströmDepartment of Respiratory Medicine and Allergy, University Hospital, Umeå, SwedenAbstract: Immunoglobulin E (IgE) is central to the pathophysiology of allergic asthma. Omalizumab, an anti-IgE monoclonal antibody, binds to the FcεRI binding site on free IgE. As a result, circulating free IgE is reduced, IgE is prevented from attaching to mast cells and basophils, and FcεRI receptor expression is down-regulated. The inflammatory respons...

  20. The value of pulmonary function tests in the management of acute asthma

    OpenAIRE

    Worthington, J R; Ahuja, J

    1989-01-01

    We examined the influence of the forced expiratory volume in 1 second (FEV1) on the decision to admit or discharge patients who present with acute bronchospasm due to asthma and the ability of the FEV1 to predict the need for admission or the likelihood of relapse after discharge. The FEV1 was recorded at presentation before treatment and immediately after a decision to admit or discharge had been made. Of the 96 patients 10.4% were admitted, 10.4% were discharged but suffered a relapse, and ...

  1. Getting the Right Staff. Personnel Management Module. Operational Management Programme. Increasing Opportunities for Supervisors and Managers.

    Science.gov (United States)

    Goddard, Tessa; Murray, Jennifer

    This self-instructional unit for supervisors and managers in the British hotel and catering industry contains information on all the important stages in the process of recruiting staff. The document begins with an introduction and advice on how to use the unit. Five sections cover the following topics: (1) the cost of employment; (2) planning for…

  2. Staff Retention. Personnel Management Module. Operational Management Programme. Increasing Opportunities for Supervisors and Managers.

    Science.gov (United States)

    Murray, Jennifer

    This self-instructional unit for supervisors and managers in the British hotel and catering industry is based on the view that problems in staff recruitment and retention are directly linked to the level of job satisfaction. The document begins with an introduction and advice on how to use the unit. Five sections cover the following topics: (1)…

  3. Making Financial Decisions. Financial Management Module. Operational Management Programme. Increasing Opportunities for Supervisors and Managers.

    Science.gov (United States)

    Adamson, Jan; And Others

    One of a series of three self-instructional units, these materials are aimed at helping British hotel and catering managers improve profits and/or reduce costs in their areas of responsibility. Following a paragraph on how to use the unit and an introduction, section 1 covers control levels as the framework for making decisions. The section…

  4. Comprehensive Approach. Challenges and opportunities in complex crisis management

    OpenAIRE

    Friis, Karsten; Jarmyr, Pia

    2008-01-01

    This report discusses challenges related to the comprehensive approach in complex crisis management today. The first chapter conceptualises ‘comprehensive approach’ by developing categories and definitions of various kinds of interactions and between various kinds of actors. The second chapter discusses five topic areas that represent a challenge to achieving a comprehensive approach: conflicting values, principles and priorities; organisational and operational challenges; how to organise a c...

  5. Efficacy of the I Can Control Asthma and Nutrition Now (ICAN) Pilot Program on Health Outcomes in High School Students with Asthma

    Science.gov (United States)

    Kouba, Joanne; Velsor-Friedrich, Barbarba; Militello, Lisa; Harrison, Patrick R.; Becklenberg, Amy; White, Barb; Surya, Shruti; Ahmed, Avais

    2013-01-01

    Asthma is the most prevalent chronic illness in childhood affecting 7 million youth. Many youth with asthma face another risk factor in obesity. Obesity, in turn, increases disorders such as asthma. Studies have recommended that asthma programs also address weight management in youth. Taking this into consideration, the I Can Control Asthma and…

  6. Effects of a self-management asthma educational program in Taiwan based on PRECEDE-PROCEED model for parents with asthmatic children.

    Science.gov (United States)

    Chiang, Li-Chi; Huang, Jing-Long; Yeh, Kuo-Wei; Lu, Chang-Ming

    2004-04-01

    This study was conducted to evaluate the comparative effectiveness of two different asthma educational programs. One was self-management asthma education based on the PRECEDE-PROCEED model to change the influential factors based on a previous need assessment study in Taiwan. The other consisted of regular outpatient asthma education. The purposes were: 1) to compare differences in the asthma knowledge, self-efficacy, perceived effectiveness, children's cooperation, doctor-patient communication, and self-management behaviors in the experimental and control groups before education, and 2 weeks, 3 months, and 6 months after education; and 2) to compare differences in drug use, medication utilization, asthma severity, signs/symptoms of asthma, school absenteeism, and exercise ability before education, and 2 weeks, 3 months, and 6 months after education. Parents of asthmatic children were recruited from among outpatients of Chang Gung Children's Hospital, Taoyuan, Taiwan. They were grouped by registration number: those with even numbers were assigned to the experimental group, and those with odd numbers were assigned to the control group. Measurements were collected four times from all parents by means of a questionnaire and chart review. The General Linear Model: Repeat Measurement was used to compare variance differences. The following results were found. 1) Asthma knowledge, self-efficacy, perceived effectiveness, children's cooperation, and self-management behaviors significantly improved after the self-management asthma educational program based on PRECEDE-PROCEED. Except for perceived effectiveness, all variables still had good effectiveness after 6 months of follow-up. The experimental group was better than the control group in knowledge, children's cooperation, and self-management behaviors at the 3-month follow up, as well as in knowledge and children's cooperation at the 6-month follow-up. 2) In both the experimental and control groups, the educational program

  7. Responsibility, opportunity, and vision for higher education in urban and regional carbon management

    OpenAIRE

    Schienke Erich W; Canan Penelope

    2006-01-01

    Abstract This is a summary of the conversation among scholars attending the special session on "Responsibility, Opportunity, and Vision for Higher Education in Urban and Regional Carbon Management" at the First International Conference on Carbon Management at Urban and Regional Levels: Connecting Development Decisions to Global Issues in Mexico City Sept. 4–8, 2006. It includes The Declaration for Carbon Management Education, agreed upon by the participants. Obstacles to such a vision were di...

  8. Rhinoviral infection and asthma: the detection and management of rhinoviruses by airway epithelial cells.

    Science.gov (United States)

    Parker, L C; Stokes, C A; Sabroe, I

    2014-01-01

    Human rhinoviruses (HRV) have been linked to the development of childhood asthma and recurrent acute asthma exacerbations throughout life, and contribute considerably to the healthcare and economic burden of this disease. However, the ability of HRV infections to trigger exacerbations, and the link between allergic status and HRV responsiveness, remains incompletely understood. Whilst the receptors on human airway cells that detect and are utilized by most HRV group A and B, but not C serotypes are known, how endosomal pattern recognition receptors (PRRs) detect HRV replication products that are generated within the cytoplasm remains somewhat of an enigma. In this article, we explore a role for autophagy, a cellular homeostatic process that allows the cell to encapsulate its own cytosolic constituents, as the crucial mechanism controlling this process and regulating the innate immune response of airway epithelial cells to viral infection. We will also briefly describe some of the recent insights into the immune responses of the airway to HRV, focusing on neutrophilic inflammation that is a potentially unwanted feature of the acute response to viral infection, and the roles of IL-1 and Pellinos in the regulation of responses to HRV.

  9. Managing Service Quality within the Knowledge-Based Economy: Opportunities and Challenges

    OpenAIRE

    Ion Plumb; Andreea Zamfir

    2009-01-01

    The knowledge-based economy, along with the impact of information society technologies, presents the service organizations and their customers with many potential opportunities as well as challenges. Therefore, this study explores how the knowledge-based economy could influence the quality management of service organizations. The study reveals that the actors within the service sector have vast new opportunities in terms of communication and value co-creation, but in the same time, the requir...

  10. Electronic Customer Relationship Management (eCRM): Opportunities and Challenges in a Digital World

    OpenAIRE

    Kennedy, Aileen

    2006-01-01

    Electronic customer relationship management (eCRM) is seen to arise from the consolidation of traditional CRM with the e-business applications marketplace and has created a flurry of activity among companies. ECRM is the proverbial double-edge sword, presenting both opportunities and challenges for companies considering its adoption and implementation. This challenges companies considering its adoption and implementation. This paper explores the marketing opportunities eCRM creates for compan...

  11. Optimal Liquidity Management and Hedging in the presence of a non predictable investment opportunity

    OpenAIRE

    Villeneuve, Stéphane; Warin, Xavier

    2012-01-01

    In this paper, we develop a dynamic model that captures the interaction between a firm’s cash reserves, the risk management policy and the profitability of a non-predictable irreversible investment opportunity. We consider a firm that has assets in place generating a stochastic cash-flow stream. The firm has a non-predictable growth opportunity to expand its operation size by paying a sunk cost. When the opportunity is available, the firm can finance it either by cash or by costly equity issu...

  12. Managing Intellectual Property in the Defense Establishment: Opportunities and Risks

    OpenAIRE

    Shmuel Even; Yesha Sivan

    2014-01-01

    In Israel, there is a consensus on the value of all knowledge generated in the defense establishment and its contribution to the economy. But in the State Comptroller’s report of March 2014, the management of intellectual property (IP) at the Ministry of Defense was described as an ongoing fiasco, with the blame ascribed to both the Ministry of Defense and the Ministry of Finance. This essay seeks to contribute to the discourse on remedying the flaws and suggest some organizing principles in ...

  13. R&D Management in Iran, Opportunities and Threats

    OpenAIRE

    Ale Ebrahim, Nader; Ghazizadeh, Ali; Golnam, Arash; Tahbaz Tavakoli, Hamid

    2007-01-01

    Research and Development (R&D) management in Iran has faced many barriers and obstacles, in which R&D units are considered as the basic core of the product development and innovation. Due to structural shortcomings, a great number of organizations and industries have not yet been able to position themselves in the market. There are about 1141 R&D units throughout Iran, due to the geographical decentralization of these units this paper considers and analyzes the R&D case study in one of the pr...

  14. Prioritising maintenance improvement opportunities in physical asset management

    Directory of Open Access Journals (Sweden)

    Von Petersdorff, Hagen

    2014-11-01

    Full Text Available Physical Asset Management (PAM initiatives suffer many barriers in implementation that can hinder their influence and sustainability. One of these barriers is the lack of buy-in from all levels in the organisation, due to a lack of understanding of the perceived benefits of PAM. Organisational alignment in a PAM project is achieved by aligning employees’ views on the deficient areas in the organisation, and managing their expectations of the perceived benefits of a good application of PAM. Barriers in implementation are created, however, by the lack of a transparent method for conveying the significance of critical areas in the system and by an unclear way of communicating these problems. Typically these initiatives are constrained by available resources. In order for PAM initiatives to be successful, there first needs to be an alignment in the execution through a clear understanding of which assets are critical, so that resources can be allocated effectively. In this study, this problem is thoroughly examined, and a method is sought that seeks to isolate the effects of the maintenance function in an operation and to uncover critical areas. A study is performed on the methods that are typically used to create such understanding. This study highlights the shortcomings of these methods, which limit their applicability. A new methodology is therefore created in order to overcome these problems. The methodology is validated through a case study, where it shown to be highly beneficial in uncovering critical areas and achieving organisational alignment through the communication of results.

  15. Are doctors still failing to assess and treat asthma attacks? An audit of the management of acute attacks in a health district.

    Science.gov (United States)

    Pinnock, H; Johnson, A; Young, P; Martin, N

    1999-06-01

    This audit aimed to observe the management of acute asthma by primary and secondary care within a Health District. Asthma attacks occurring during the first 6 weeks of 1996 to patients between the ages of 3 and 74 years in Canterbury and Thanet District were notified by general practitioners, out-of-hours co-operatives and hospitals. Data were obtained retrospectively from the patient records. A total of 378 episodes was registered: 342 (90%) to primary care. Of these 234 (76% of patients aged 6 years or over) had a peak flow recorded; 114 (30%) were given emergency bronchodilation: oxygen was not used in primary care; 204 (54%) were given systemic steroids; and 43 (11%) were referred for hospital care of whom 36 were admitted. Of the attacks, 212 (69% of the patients aged 6 years or over) could be classified by percentage predicted peak flow and management compared to the Guidelines published by the British Thoracic Society. Twenty-eight patients presented with 'life-threatening' asthma: 20 (71%) were given emergency bronchodilation; oxygen was used in only two; 24 (86%) were given systemic steroids; and six (21%) were referred for admission. In their confidential enquiry into the asthma deaths the British Thoracic Society identified a failure to appreciate the severity of the attack, resulting in inadequate emergency treatment and delay in referring to hospital. These data suggest that, 15 years later, these problems may still exist.

  16. Management based on exhaled nitric oxide levels adjusted for atopy reduces asthma exacerbations in children: A dual centre randomized controlled trial.

    Science.gov (United States)

    Petsky, Helen L; Li, Albert M; Au, Chun T; Kynaston, Jennifer A; Turner, Catherine; Chang, Anne B

    2015-06-01

    While several randomized control trials (RCTs) have evaluated the use of fractional exhaled nitric oxide (FeNO) to improve asthma outcomes, none used FeNO cut-offs adjusted for atopy, a determinant of FeNO levels. In a dual center RCT, we assessed whether a treatment strategy based on FeNO levels, adjusted for atopy, reduces asthma exacerbations compared with the symptoms-based management (controls). Children with asthma from hospital clinics of two hospitals were randomly allocated to receive an a-priori determined treatment hierarchy based on symptoms or FeNO levels. There was a 2-week run-in period and they were then reviewed 10 times over 12-months. The primary outcome was the number of children with exacerbations over 12-months. Sixty-three children were randomized (FeNO = 31, controls = 32); 55 (86%) completed the study. Although we did achieve our planned sample size, significantly fewer children in the FeNO group (6 of 27) had an asthma exacerbation compared to controls (15 of 28), P = 0.021; number to treat for benefit = 4 (95% CI 3-24). There was no difference between groups for any secondary outcomes (quality of life, symptoms, FEV1 ). The final daily inhaled corticosteroids (ICS) dose was significantly (P = 0.037) higher in the FeNO group (median 400 µg, IQR 250-600) compared to the controls (200, IQR100-400). Taking atopy into account when using FeNO to tailor asthma medications is likely beneficial in reducing the number of children with severe exacerbations at the expense of increased ICS use. However, the strategy is unlikely beneficial for improving asthma control. A larger study is required to confirm or refute our findings.

  17. Awareness regarding childhood asthma in Saudi Arabia

    Science.gov (United States)

    Al-Harbi, Saleh; Al-Harbi, Adel S.; Al-Khorayyef, Abdullah; Al-Qwaiee, Mansour; Al-Shamarani, Abdullah; Al-Aslani, Wafa; Kamfar, Hayat; Felemban, Osama; Barzanji, Mohammed; Al-Harbi, Naser; Dhabab, Ruqaia; Al-Omari, Mohammed Ahmed; Yousef, Abdullah

    2016-01-01

    OBJECTIVE: Assessing the knowledge and awareness of the Saudi society about bronchial asthma in children. METHODS: Structured questionnaires were randomly distributed to 1039 Saudi Arabians in May 2014 at Jeddah, Riyadh, and Dammam. RESULTS: The awareness of bronchial asthma questions showed that 67% of total sample thought that it could be a fatal disease, and only 13.2% thought that there is a difference between bronchial asthma and chest allergies in children. 86.1% thought that the symptoms of bronchial asthma include dyspnea and nocturnal cough, and 45.7% thought that fever, a runny nose and throat inflammation are not symptoms. 60.2% thought that infectious respiratory diseases may increase bronchial asthma progression. In addition, 40% thought that the use of antibiotics doesn’t help in diminishing bronchial asthma complications, and some thought that the patient can stop medication after an acute asthma attack. 34.1% thought that inhaled medication for asthma doesn’t cause addiction. Very highly significant results are shown between bronchial asthma knowledge and age, the level of education, marital status, and if the individual knows a person who suffers from bronchial asthma (P < 0.001). There are positive correlations between bronchial asthma knowledge and age, marital status, and level of education (r = 0.152, 0.150, 0.197), respectively. CONCLUSION: The study demonstrated that bronchial asthma knowledge in the Saudi Arabian population is insufficient, and efforts should be carried out to spread bronchial asthma management. PMID:26933459

  18. Asthma mortality in the Danish child population

    DEFF Research Database (Denmark)

    Jørgensen, Inger Merete; Jensen, V B; Bülow, S;

    2003-01-01

    Child death due to asthma is a rare and potentially preventable event. We investigated possible risk factors for death due to asthma in children and adolescents, as a step towards preventing or minimizing asthma death in this age group, and improving asthma management and care. We reviewed all 108...... cases of asthma death in 1-19-year-olds in Denmark, 1973-1994. Copies of death certificates, hospital records, information from general practitioners, and autopsy records were obtained. The information was assessed with particular reference to: features and duration of asthma before death; severity...... of asthma; time and place of death; long-term and ongoing medical treatment; quality of medical care; circumstances of final illness; and medical treatment during the final episode of asthma. Age groups of 1-4 years, 5-14 years, and 15-19 years were analyzed separately and in aggregate. Death occurred...

  19. The Use of Behavior Change Theory in Internet-Based Asthma Self-Management Interventions: A Systematic Review

    OpenAIRE

    Al-Durra, Mustafa; Torio, Monika-Bianca; Cafazzo, Joseph A

    2015-01-01

    Background The high prevalence rate of asthma represents a major societal burden. Advancements in information technology continue to affect the delivery of patient care in all areas of medicine. Internet-based solutions, social media, and mobile technology could address some of the problems associated with increasing asthma prevalence. Objective This review evaluates Internet-based asthma interventions that were published between 2004 and October 2014 with respect to the use of behavioral cha...

  20. CSACI position statement: systemic effect of inhaled corticosteroids on adrenal suppression in the management of pediatric asthma

    OpenAIRE

    Issa-El-Khoury, Karine; Kim, Harold; Chan, Edmond S; Vander Leek, Tim; Noya, Francisco

    2015-01-01

    Asthma is a chronic inflammatory disease of the airways that affects a growing number of children and adolescents. Inhaled corticosteroids (ICS) are the mainstay of treatment in persistent asthma, with a stepwise approach to increasing doses of ICS depending on asthma severity and control. ICS have known local and systemic side effects, of which adrenal suppression is still under-recognized. The latter is associated with chronic exposure and higher doses, although it has rarely been reported ...

  1. Opportunities of Establishment of Destination Management and Marketing Organizations in Bulgaria

    Directory of Open Access Journals (Sweden)

    Venelin Terziev

    2015-06-01

    Full Text Available The paper examines tourism sector development in the Republic of Bulgaria in the context of the country’s strategic priorities till 2020 of knowledge-based economy, sustainable growth and smart specialization, the opportunities for its integration with agri-food sector and potential contribution to balanced rural development. The principles and roles of destination management and marketing organizations are discussed and the opportunities for their application in the national conditions are explored. A framework for of establishment, management and functioning of such organizations is proposed based on integrated and participatory approaches, planning, coordination and communication activities, permanent monitoring and controlling.

  2. Use of medicinal herbs by patients with severe asthma managed at a Referral Center

    Directory of Open Access Journals (Sweden)

    Tacila Pires Mega

    2011-09-01

    Full Text Available Asthma is a chronic inflammatory disease of the airways that may lead to limitations in regular activities, to hospitalizations and a decrease in quality of life. Adherence to drug treatment is crucial for control of the disease. The use of medicinal herbs can reduce adherence to prescriptions, as the medication may be replaced by infusions or herbal products. The objective of this study was to evaluate the frequency of use of traditional herbal medicine among severe asthmatics in Salvador. Information on use of homemade remedies was obtained through application of a questionnaire during patient visits to a referral center. We also collected data on economic and social aspects as well as disease control. One hundred and forty-four (91,1% out of one hundred and fifty-eight patients evaluated used herbal medicines, but only 26.5% attributed improvement of asthma symptoms to this alternative treatment and only 8 had substituted a prescribed medication by herbal medicines. There was a trend towards lower adherence to prescription drug treatment in this group of patients. Despite the high frequency of use of medicinal herbs in our sample, there was no improvement in the asthma treatment in this population compared to non-users. Adherence to conventional drug treatment was satisfactory and there was neither reduction in asthma control nor increase in hospitalizations among the users of medicinal plants.A asma é uma enfermidade inflamatória crônica das vias aéreas que pode resultar em limitações nas atividades diárias, internações e prejuízo da qualidade de vida. A adesão ao tratamento medicamentoso é fundamental para o controle da doença. O uso de plantas medicinais pode reduzir a adesão ao tratamento prescrito, à medida que os medicamentos são substituídos por chás ou ervas. O objetivo deste estudo foi avaliar a frequência de uso de plantas medicinais entre asmáticos graves em Salvador. As informações sobre uso de rem

  3. OPPORTUNITIES TO IMPROVE THE MANAGEMENT METHODS OF ROMANIAN ORGANIZATIONS

    Directory of Open Access Journals (Sweden)

    Gheorghe Gabriela

    2013-07-01

    Full Text Available Information Technology has responded to the crisis by change and innovation. Competitive organizations are permanently prepared to identify the cutting-edge technologies which will change the future in business by using the concept of Business Intelligence. Information Technology is developing rapidly and providing decision makers with large amounts of information that require processing and analysis. Business Intelligence are critical decisions support applications, their role being to provide to management, based on information from the company, a landscape of its situation at some time, but also predictions on the medium and long term. This paper describes the architecture of the Business Intelligence Platform and highlights the benefits of using decision support systems for business applications. Nowadays, company executives require relevant and accurate business information in real-time to take strategic decisions. It is also essential to have freedom to access this information anywhere and anytime. There is a real need to extend this functionality beyond the office and on the fingertips of the decision makers. After a presentation of the concept of Data mining with examples from a case study, the paper focuses on the potential of the IT&C decisional sector, which embeds simulation and assistance tools for managerial decisions. Developing new methods for predictive modelling and application of existing techniques in many areas will be a permanent concern for both researchers and companies that are interested to gain competitive advantages.

  4. Managing workplace depression: an untapped opportunity for occupational health professionals.

    Science.gov (United States)

    Putnam, Kelly; McKibbin, Laura

    2004-03-01

    Depression is one of the most prevalent and costly health issues affecting the American work force. Despite well established research demonstrating the association between employee depression and reduced on-the-job productivity, increased absenteeism, and higher health care use, most employers remain largely unresponsive to the need for company based depression initiatives. Organizational and individual barriers can prevent companies from effectively managing employee depression. Organizational barriers include information gaps, lack of data to justify increased investment in employee mental health programs, and employers' ambiguous roles in addressing depression. Individual barriers such as an inability to recognize signs and symptoms; stigma; confidentiality and privacy concerns; and unavailability of easily accessible, quality resources can keep employees who are depressed from seeking treatment. Many occupational health professionals may feel ill prepared or uncomfortable taking the lead in creating more aggressive worksite responses to depression, but they are, perhaps, in the best of all possible positions within an organization to succeed. Occupational health professionals have the credentials, credibility, training, and experience necessary to build a strong case for business leaders for why investing in workplace depression programs is so important. Occupational health professionals are the most qualified to design and deliver destigmatized, customer friendly programs and services for employees to access for help with depression, and to integrate their services with other departments such as benefits, health promotion, EAP, and human resources, to create an effective, organization-wide depression initiative.

  5. The Saudi Initiative for asthma

    Directory of Open Access Journals (Sweden)

    Al-Moamary Mohamed

    2009-01-01

    Full Text Available The Saudi Initiative for Asthma (SINA provides up-to-date guidelines for healthcare workers managing patients with asthma. SINA was developed by a panel of Saudi experts with respectable academic backgrounds and long-standing experience in the field. SINA is founded on the latest available evidence, local literature, and knowledge of the current setting in Saudi Arabia. Emphasis is placed on understanding the epidemiology, pathophysiology, medications, and clinical presentation. SINA elaborates on the development of patient-doctor partnership, self-management, and control of precipitating factors. Approaches to asthma treatment in SINA are based on disease control by the utilization of Asthma Control Test for the initiation and adjustment of asthma treatment. This guideline is established for the treatment of asthma in both children and adults, with special attention to children 5 years and younger. It is expected that the implementation of these guidelines for treating asthma will lead to better asthma control and decrease patient utilization of the health care system.

  6. Challenges and Opportunities of Air Quality Management in Mexico City

    Science.gov (United States)

    Paramo, V.

    2013-05-01

    The Mexico City Metropolitan Area (MCMA) is located in the central plateau of Mexico and is the capital of the country. Its natural characteristics present favorable conditions for air pollution formation and accumulation: mountains surrounding the city, frequent thermal inversions, high isolation all around the year and weak winds. To these natural conditions, a population of more than 20 million inhabitants, a fleet of 4.5 million vehicles and more than 4 thousands industries, make air quality management a real challenge for governments of the region. Intensive air quality improvement actions and programs began at the end of the 1980's and continued nowadays. Since then criteria air pollutants concentrations have decreased in such a way that currently most of pollutants meet the Mexican air quality standards, except for ozone and particulate matter. Applied measures comprised of fuel quality improvements, fuel replacements, regulations for combustion processes, closing of high polluting refineries and industries, regulations of emissions for new and on road vehicles, mandatory I/M programs for vehicles, circulation restrictions for vehicles (Day without car program), alert program for elevated air pollution episodes, improvement of public transportation, among others. Recent researches (MILAGRO 2006 campaign) found that currently it is necessary to implement emissions reduction actions for Volatile Organic Compounds, particulate matter with a diameter of less than 2.5 micrometers PM2.5 and Nitrogen Oxides, in order to reduce concentrations of ozone and fine particulate matter. Among the new measures to be implemented are: regulations for VOCs emissions in the industry and commercial sectors; regulation of the diesel fleet that includes fleets renewal, filters and particulate traps for in use vehicles and regulation of the cargo fleet; new schemes for reducing the number of vehicles circulating in the city; implementation of non-motorized mobility programs; among

  7. CO2 exsolution - challenges and opportunities in subsurface flow management

    Science.gov (United States)

    Zuo, Lin; Benson, Sally

    2014-05-01

    for storage security. Falta et al. [2013] show that if carbonated brine migrates upwards and exsolution occurs, brine migration would be greatly reduced and limited by the presence of exsolved CO2 and the consequent low relatively permeability to brine. Similarly, if an exsolved CO2 phase were to evolve in seals, for example, after CO2 injection stops, the effect would be to reduce the permeability to brine and the CO2 would have very low mobility. This flow blocking effect is also studied with water/oil/CO2 [Zuo et al., 2013]. Experiments show that exsolved CO2 performs as a secondary residual phase in porous media that effectively blocks established water flow paths and deviates water to residual oil zones, thereby increasing recovery. Overall, our studies suggest that CO2 exsolution provides an opportunity for mobility control in subsurface processes. However, the lack of simulation capability that accounts for differences between gas injection and gas exsolution creates challenges for modeling and hence, designing studies to exploit the mobility reduction capabilities of CO2 exsolution. Using traditional drainage multiphase flow parameterization in simulations involving exsolution will lead to large errors in transport rates. Development of process dependent parameterizations of multiphase flow properties will be a key next step and will help to unlock the benefits from gas exsolution. ACKNOWLEDGEMENT This work is funded by the Global Climate and Energy Project (GCEP) at Stanford University. This work was also supported by U.S. EPA, Science To Achieve Results (STAR) Program, Grant #: 834383, 2010-2012. REFERENCES Falta, R., L. Zuo and S.M. Benson (2013). Migration of exsolved CO2 following depressurization of saturated brines. Journal of Greenhouse Gas Science and Technology, 3(6), 503-515. Zuo, L., S.C.M. Krevor, R.W. Falta, and S.M. Benson (2012). An experimental study of CO2 exsolution and relative permeability measurements during CO2 saturated water

  8. Implementation of a 12-week disease management program improved clinical outcomes and quality of life in adults with asthma in a rural district hospital: pre- and post-intervention study.

    Science.gov (United States)

    Chamnan, Parinya; Boonlert, Kittipa; Pasi, Wanit; Yodsiri, Songkran; Pong-on, Sirinya; Khansa, Bhoonsab; Yongkulwanitchanan, Pichapat

    2010-03-01

    Despite the availability of effective medical treatment and disease management guidelines, asthma remains a poorly controlled disease in developing countries. There is little evidence of the effectiveness of disease management guidelines in rural clinical practice. The effect of disease management guidelines on clinical outcomes and quality of life in asthmatic patients in a rural community hospital was examined. Fifty-seven patients aged > or = 16 years with physician-diagnosed asthma from a hospital outpatient clinic in Ubon-ratchathani, Thailand, were recruited. Asthma diagnosis was confirmed by reviewing clinical records. We implemented a 12-week disease management program, including the use of written asthma treatment plan and asthma action plan tailored to individual patients. Using one-group pre- and post-intervention design, we compared the average number of emergency visits and hospitalizations from acute asthmatic attacks before and after the implementation of interventions using the Wilcoxon matched-pairs signed-rank test. We also compared patient's asthma quality of life (AQL) scores, measured using the 7-point scaled Mini Asthma Quality of Life Questionnaire. It was found that among the 57 patients, 38 (67%) were women, and the mean age (SD) of the patients was 47.6 (17.0) years. Sixteen patients (28%) had a family history of asthma. Emergency visits decreased from 0.48 (SD = 0.83) per patient before implementation of interventions to 0.11 (0.37) per patient after implementation of interventions (p = 0.003). Hospitalizations with acute asthma attacks reduced from 0.14 (0.35) per patient to 0.04 (0.27) per patient (p = 0.034). Overall AQL scores increased significantly from 3.7 to 5.4 (p management program could reduce emergency visits and hospitalizations, and improve patients' quality of life in a rural practice setting.

  9. Encuesta sobre cambios en el manejo y tratamiento del asma bronchial Survey on changes in asthma treatment and management

    Directory of Open Access Journals (Sweden)

    Guillermo A. Raimondi

    2004-06-01

    con las pautas de calidad aceptadas o con los guías de manejo de la enfermedad.A total of 518 chest physicians selected at random from a national list participated in a survey on asthma management. This paper dealt with queries about diagnostic procedures, methods for recognizing life-threatening asthma attacks, patient education and treatment for acute asthma in adults and in children older than 6 years. A total of 198 replies were received (38.2% of questionnaires mailed. A mean score of frequency of use (from 0 = never to 3 = always was used for assessing the responses. Results were compared with a similar survey performed in 1994, disclosing a satisfactory trend in diagnostic tests with the bronchodilator test and in oral steroid courses (2.74 ±2.3 vs 2.30±1.05 and 1.26±0.96 vs 0.98+±0.84, respectively. Skin tests were less used (0.50±0.83 vs 0.88±1.08. Results reporting how to assess the severity of asthma attacks, such as taking into account symptoms or drop in PEFR, were more frequent in the present study (2.65±0.66 vs 2.29±0.90 and 1.93±1.05 vs 1.51±1.20, respectively. PEFR or spirometry used by the physician for assessing severity of asthma attacks was not always performed and its comparison was no better than in 1994 (2.14±1.04 vs 2.13±0.70. Data regarding patient information and education ranked equal or better than in the 1994 survey. For the treatment of acute severe episodes, almost all responders in the present study chose inhaled b2 agonists (IBA for adults and children, thus improving with respect to the previous study (first option 85.3 vs 57.5% and 81.0 vs 63.4%, respectively. For maintenance therapy, a good trend was also observed with more responders who now chose inhaled steroid (IS as a first choice formulation, specially in children (2.09±1.01 vs 1.61±1.00. The average normal and maximal daily doses of IS for adults and children were higher than in 1994 and were now in agreement with recommended doses. The recommendation of short

  10. Prescribed therapy for asthma: therapeutic ratios and outcomes

    OpenAIRE

    Laforest, Laurent; Licaj, Idlir; Devouassoux, Gilles; Eriksson, Irene; Caillet, Pascal; Chatte, Gérard; Belhassen, Manon; Van Ganse, Eric

    2015-01-01

    Background Inhaled corticosteroids (ICS) are the cornerstone of asthma therapy. The ICS-to-total-asthma-medication ratios, calculated from claims data, indicate potentially risky disease management in asthma. Our aim was to assess the utility of ICS-to-total-asthma-medication ratios from primary care electronic medical records (EMRs) in detecting patients at risk of asthma exacerbation, as approached by prescription of oral corticosteroids and/or antibiotics. Methods Retrospective cohort stud...

  11. Therapeutic options for severe asthma

    OpenAIRE

    Mathew, Jilcy; Aronow, Wilbert S.; Chandy, Dipak

    2012-01-01

    As the overall prevalence of asthma has escalated in the past decades, so has the population of patients with severe asthma. This condition is often difficult to manage due to the relative limitation of effective therapeutic options for the physician and the social and economic burden of the disease on the patient. Management should include an evaluation and elimination of modifiable risk factors such as smoking, allergen exposure, obesity and non-adherence, as well as therapy for co-morbidit...

  12. Canadian asthma consensus report, 1999

    OpenAIRE

    Boulet, L. P.; A. Becker; Bérubé, D; Beveridge, R.; Ernst, P

    1999-01-01

    OBJECTIVES: To provide physicians with current guidelines for the diagnosis and optimal management of asthma in children and adults, including pregnant women and the elderly, in office, emergency department, hospital and clinic settings. OPTIONS: The consensus group considered the roles of education, avoidance of provocative environmental and other factors, diverse pharmacotherapies, delivery devices and emergency and in-hospital management of asthma. OUTCOMES: Provision of the best control o...

  13. Mexican Political Development, Common Property Institutions, and Opportunities for Collaborative Environmental Management

    OpenAIRE

    Garrett, Benjamin Goggin

    2003-01-01

    The political, economic, and social institutions within a society directly influence the structure, direction, and vitality of collaborative or co-management systems of environmental management and governance. Mexico has the opportunity to more fully embrace sound progressive environmental policies because of the dramatic political and economic developments of the last twenty years; particularly the signing of the NAFTA accords in 1992 and the elections of 2000. The ejido, or common propert...

  14. Validation of The 30 Second Asthma Test™ as a measure of asthma control

    OpenAIRE

    Sara Ahmed; Pierre Ernst; Robyn Tamblyn; Neil Colman

    2007-01-01

    BACKGROUND: The primary objective of asthma management is to help patients establish and maintain optimal disease control. Simple and efficient tools are needed to assess patient-reported symptoms so that they can be used with or without airway function to evaluate asthma control.OBJECTIVE: The objective of the present study was to evaluate the validity of The 30 Second Asthma Test (GlaxoSmithKline Inc, Canada), based on the Canadian Asthma Guidelines, by estimating its relationship with crit...

  15. The Business School in Transition: New Opportunities in Management Development, Knowledge Transfer and Knowledge Creation

    Science.gov (United States)

    Harrington, Denis; Kearney, Arthur

    2011-01-01

    Purpose: This paper aims to consider the extent to which business school transition has created new opportunities in management development, knowledge transfer and knowledge creation. Design/methodology/approach: The paper is a critical review of knowledge exchange in a business school context with a particular focus on the "translation or…

  16. The Dynamics of Opportunity and Threat Management in Turbulent Environments: The Role of Information Technologies

    Science.gov (United States)

    Park, Young Ki

    2011-01-01

    This study explains the role of information technologies in enabling organizations to successfully sense and manage opportunities and threats and achieve competitive advantage in turbulent environments. I use two approaches, a set-theoretic configurational theory approach and a variance theory approach, which are theoretically and methodologically…

  17. Salmeterol in paediatric asthma

    OpenAIRE

    Byrnes, C; Shrewsbury, S.; Barnes, P; Bush, A

    2000-01-01

    BACKGROUND—The addition of long acting inhaled β2 agonists is recommended at step 3 of the British guidelines on asthma management but a recent study suggested no additional benefit in children with asthma.
METHODS—The aim of this study was to compare, in a double blind, three way, crossover study, the effects of the addition of salmeterol 50 µg bd, salmeterol 100 µg bd, and salbutamol 200 µg qds in asthmatic children who were symptomatic despite treatment with inhaled co...

  18. Surprise and opportunity for learning in Grand Canyon: the Glen Canyon Dam Adaptive Management Program

    Science.gov (United States)

    Melis, Theodore S.; Walters, Carl; Korman, Josh

    2015-01-01

    With a focus on resources of the Colorado River ecosystem below Glen Canyon Dam, the Glen Canyon Dam Adaptive Management Program has included a variety of experimental policy tests, ranging from manipulation of water releases from the dam to removal of non-native fish within Grand Canyon National Park. None of these field-scale experiments has yet produced unambiguous results in terms of management prescriptions. But there has been adaptive learning, mostly from unanticipated or surprising resource responses relative to predictions from ecosystem modeling. Surprise learning opportunities may often be viewed with dismay by some stakeholders who might not be clear about the purpose of science and modeling in adaptive management. However, the experimental results from the Glen Canyon Dam program actually represent scientific successes in terms of revealing new opportunities for developing better river management policies. A new long-term experimental management planning process for Glen Canyon Dam operations, started in 2011 by the U.S. Department of the Interior, provides an opportunity to refocus management objectives, identify and evaluate key uncertainties about the influence of dam releases, and refine monitoring for learning over the next several decades. Adaptive learning since 1995 is critical input to this long-term planning effort. Embracing uncertainty and surprise outcomes revealed by monitoring and ecosystem modeling will likely continue the advancement of resource objectives below the dam, and may also promote efficient learning in other complex programs.

  19. FDA's recommendations on the use of long-acting {beta}2 agonists in the management of asthma.

    Science.gov (United States)

    Robinson, Christie A

    2010-10-01

    The revised labeling for long-acting β(2) agonists (LABAs) by the Food and Drug Administration (FDA) is controversial and in part is inconsistent with the 2007 National Asthma Education and Prevention Program asthma guidelines. Two large randomized controlled studies, the Serevent Nationwide Surveillance (SNS) study and the Salmeterol Multicenter Asthma Research Trial (SMART), and a 2008 meta-analysis conducted by the FDA were the main sources of information used to determine the label changes. A paucity of large, well-designed, controlled, prospective studies evaluating the asthma-related risks associated with LABAs makes it difficult to reach a consensus regarding how best to use LABAs in patients with asthma. PMID:20841520

  20. Asthma pharmacotherapy.

    Science.gov (United States)

    Schofield, Minka L

    2014-02-01

    Asthma is a chronic inflammatory disease of the airway that leads to airway obstruction via bronchoconstriction, edema, and mucus hypersecretion. The National Asthma Education and Prevention Program has outlined evidence-based guidelines to standardize asthma therapy and improve outcomes. The initial recommendation of choice for persistent asthmatic patients is an inhaled corticosteroid (ICS). Long-acting beta-2 agonists in combination with ICS, oral corticosteroids, leukotriene modifiers, and anti-IgE therapeutic options can be considered for patients with persistent or worsening symptoms. Many novel therapies are being developed, with an emphasis on anti-inflammatory mechanisms, gene expression, and cytokine modification.

  1. Asthma and allergy - resources

    Science.gov (United States)

    Resources - asthma and allergy ... The following organizations are good resources for information on asthma and allergies : Allergy and Asthma Network Mothers of Asthmatics -- www.aanma.org American Academy of Allergy, Asthma ...

  2. How Is Asthma Diagnosed?

    Science.gov (United States)

    ... page from the NHLBI on Twitter. How Is Asthma Diagnosed? Your primary care doctor will diagnose asthma ... other disease may be causing your symptoms. Diagnosing Asthma in Young Children Most children who have asthma ...

  3. Exercise and Asthma

    Science.gov (United States)

    ... Issues Listen Español Text Size Email Print Share Exercise and Asthma Page Content Article Body Almost every ... children more likely to develop asthma. How does exercise cause asthma symptoms? The symptoms of asthma are ...

  4. Risks and opportunities management on laser Megajoule project: the development of a new knowledge

    International Nuclear Information System (INIS)

    The interest of these six years spent to build the management through the Risks and the Opportunities (R and O) approach on the project Megajoule Laser as well did not hold with the practical application of a method as to the installation of a formal culture and to its evolution in time. This culture, it had to be progressively founded within a mainly technical project team. More qualitative with most quantitative aspects, the putting into practice of the R and O approach on project LMJ knew all the degrees of evolution and precision. The starting of the project saw being born the first analysis of its 'Project Risk' with a series of interviews, carried out by the Quality Manager at the time. This analysis took the shape of a technical item lists, which are identified in an empirical way. Then, some brainstorming meeting were led under the responsibility of the Technical Coordinator (which is the Project Manager assistant) in order to identify and to evaluate the 'Project Risk' on a qualitative way, but always keeping a strong technical connotation. The methodological reference of the 'Project Risk' was outlined taking into account the DGA AQ 923 without directly interaction with the other project processes (for example, the cost, the deadlines and the performance management). Initially, the project developed an Access database, which allows the storing of the risk files. Unfortunately, this database is isolated from the other project management data processing tools. In the second time, the project decided to obtain a dedicated organisation, hierarchically independent from the technical managers but however integrated into the project and attached to the assistant of the Control Project Manager. This organisation being called 'Risks and Opportunities Team', when the management of the opportunities supplemented the R and O approach. This team combines today the individual interviews and the Working Groups in order to identify and to evaluate the effects of the R

  5. Childhood Asthma

    Science.gov (United States)

    ... Training Grants & Awards Program Directors Practice Resources ASTHMA IQ Consultation and Referral Guidelines Practice Financial Survey Practice ... one child. Unfortunately, there is not a single test that provides all the answers. An allergist / immunologist, ...

  6. Occupational asthma

    Science.gov (United States)

    ... occupational exposure; Irritant-induced reactive airways disease Images Spirometry Respiratory system References Lemiere C, Vandenplas O. Occupational allergy and asthma. In: Adkinson NF Jr., Bochner BS, Burks AW, ...

  7. DOE Low-Level Waste Management Program perspective on technology transfer: opportunities and challenges

    International Nuclear Information System (INIS)

    The Department of Energy's Low-Level Waste Management Program (DOE LLWMP) perspective in regard to transfer of LLWMP technology to current and potential users in both the commercial and defense sectors is discussed. Past, present, and future opportunities and challenges for the whole nuclear waste management are indicated. Elements considered include: historical and evolutionary events and activities; the purpose of the Program and its inherent opportunities and challenges; achievements and expected accomplishments; supporters and interactors; packaging and delivering technology; implementing and serving potential users; determining and meeting users' needs; and identifying and responding to opportunities and challenges. The low-level waste management effort to improve shallow land burial technology began in FY 1977 and has expanded to include waste treatment and alternative disposal methods. Milestones have been established and are used as principal management control items. This technology, the Program Product, is described and is made available. This year, the Program has drafted criteria for inclusion in a DOE order for radioactive waste management operations at DOE sites

  8. Implementation strategies of internet-based asthma self-management support in usual care. Study protocol for the IMPASSE cluster randomized trial

    Directory of Open Access Journals (Sweden)

    van Gaalen Johanna L

    2012-11-01

    Full Text Available Abstract Background Internet-based self-management (IBSM support cost-effectively improves asthma control, asthma related quality of life, number of symptom-free days, and lung function in patients with mild to moderate persistent asthma. The current challenge is to implement IBSM in clinical practice. Methods/design This study is a three-arm cluster randomized trial with a cluster pre-randomisation design and 12 months follow-up per practice comparing the following three IBSM implementation strategies: minimum strategy (MS: dissemination of the IBSM program; intermediate strategy (IS: MS + start-up support for professionals (i.e., support in selection of the appropriate population and training of professionals; and extended strategy (ES: IS + additional training and ongoing support for professionals. Because the implementation strategies (interventions are primarily targeted at general practices, randomisation will occur at practice level. In this study, we aim to evaluate 14 primary care practices per strategy in the Leiden-The Hague region, involving 140 patients per arm. Patients aged 18 to 50 years, with a physician diagnosis of asthma, prescription of inhaled corticosteroids, and/or montelukast for ≥3 months in the previous year are eligible to participate. Primary outcome measures are the proportion of referred patients that participate in IBSM, and the proportion of patients that have clinically relevant improvement in the asthma-related quality of life. The secondary effect measures are clinical outcomes (asthma control, lung function, usage of airway treatment, and presence of exacerbations; self-management related outcomes (health education impact, medication adherence, and illness perceptions; and patient utilities. Process measures are the proportion of practices that participate in IBSM and adherence of professionals to implementation strategies. Cost-effective measurements are medical costs and healthcare consumption

  9. Treatment efficacy evaluation of standardized management for children with asthma%儿童哮喘规范化管理治疗效果评价

    Institute of Scientific and Technical Information of China (English)

    马旭升; 涂林修; 梅依君; 毕海燕; 余胜波; 王辉杰; 王财富; 陈志敏

    2015-01-01

    目的:评价儿童哮喘规范化管理治疗的效果。方法对150例哮喘患儿建立哮喘医疗管理档案,按是否接受规范化管理治疗分为管理组和对照组,对管理组78例患儿及家长进行哮喘基本知识教育、健康教育并定期随访等综合教育管理,同时进行哮喘的规范化治疗;对照组72例未进行哮喘教育管理,仅接受一般临床治疗。观察1年,比较两组儿童哮喘临床疗效、家长知信行变化及患儿用药依从性情况。结果管理组患儿哮喘控制率明显高于对照组(χ2=54.68,P<0.01);在随访1年内,管理组患儿哮喘发作次数、急诊次数、住院次数均明显减少,与对照组比较差异有统计学意义(P均<0.01);两组比较,管理组患儿家长对哮喘知识的了解和对患儿治疗及管理执行情况等知信行水平显著提高(P<0.01);同期管理组患儿用药依从性也显著高于对照组(χ2=66.27,P<0.01)。结论推广儿童哮喘规范化管理治疗,可提高哮喘患儿家长的知信行水平,改善患儿治疗依从性,从而有效控制哮喘。%ObjectiveTo evaluate the treatment efifcacy of the treatment promotion of standardized management for chil-dren with asthma.MethodsMedical records of 150 children with asthma were reviewed and divided into management group or control group according to whether standardized management was accepted. Comprehensive asthma education for asthma pa-tients and their parents including asthma associated basic knowledge education, health education as well as follow-ups at deifned intervals was conducted in 78 cases. In the meantime, standardized asthma therapies were performed. Control group involved 72 cases who did not receive asthma education managements and only accepted regular clinical therapies. After 1-year observational follow-up, , clinical efifcacy of children with asthma, changes of knowledge-attitude-practice of parents, and compliance of med

  10. Evidence for the efficacy and safety of anti-interleukin-5 treatment in the management of refractory eosinophilic asthma.

    Science.gov (United States)

    Hilvering, Bart; Xue, Luzheng; Pavord, Ian D

    2015-08-01

    Two recent phase III trials in patients with severe eosinophilic asthma have shown that anti-interleukin 5 (IL-5) therapy with mepolizumab reduces the frequency of asthma attacks, improves symptoms and allows patients to reduce oral glucocorticoid use without loss of control of asthma. An earlier large 616 patient Dose Ranging Efficacy And safety with Mepolizumab in severe asthma (DREAM) study had shown that the only variables associated with treatment efficacy were a prior history of asthma attacks and the peripheral blood eosinophil count. The link between blood eosinophil counts and treatment efficacy is biologically obvious given that IL-5 has a pivotal role in eosinophil production, proliferation and chemotaxis. It is also clinically relevant as the blood eosinophil count is routinely measured and thus readily available in patients with asthma. Recognition of the link between airway or blood eosinophilia and treatment response was also important in the clinical testing of the alternative IL-5 blocker, such as reslizumab, which is currently being evaluated in a phase III randomized controlled trial (RCT) after having shown to improve lung function, improve symptom score and reduce sputum eosinophilia in a smaller phase IIb study. In addition, benralizumab, an IL-5α receptor blocker, has shown good effects in a phase IIb RCT with patients with severe asthma that had sputum eosinophilia and more recently in a phase IIa trial with patients with eosinophilic chronic obstructive pulmonary disease. Therefore anti-IL-5 treatment seems generally effective in eosinophilic asthma, either assessed by blood or airway eosinophilia. This factor together with the impressive clinical efficacy and good safety profile make anti-IL-5 (mepolizumab, reslizumab) and benralizumab (anti-IL-5 receptor α) very promising drugs for the treatment of patients with severe eosinophilic asthma, a subgroup that is in desperate need of better treatments. PMID:25900924

  11. Improving asthma during pregnancy with dietary antioxidants: the current evidence.

    Science.gov (United States)

    Grieger, Jessica A; Wood, Lisa G; Clifton, Vicki L

    2013-08-14

    The complication of asthma during pregnancy is associated with a number of poor outcomes for the mother and fetus. This may be partially driven by increased oxidative stress induced by the combination of asthma and pregnancy. Asthma is a chronic inflammatory disease of the airways associated with systemic inflammation and oxidative stress, which contributes to worsening asthma symptoms. Pregnancy alone also intensifies oxidative stress through the systemic generation of excess reactive oxidative species (ROS). Antioxidants combat the damaging effects of ROS; yet antioxidant defenses are reduced in asthma. Diet and nutrition have been postulated as potential factors to combat the damaging effects of asthma. In particular, dietary antioxidants may play a role in alleviating the heightened oxidative stress in asthma. Although there are some observational and interventional studies that have shown protective effects of antioxidants in asthma, assessment of antioxidants in pregnancy are limited and there are no antioxidant intervention studies in asthmatic pregnancies on asthma outcomes. The aims of this paper are to (i) review the relationships between oxidative stress and dietary antioxidants in adults with asthma and asthma during pregnancy, and (ii) provide the rationale for which dietary management strategies, specifically increased dietary antioxidants, might positively impact maternal asthma outcomes. Improving asthma control through a holistic antioxidant dietary approach might be valuable in reducing asthma exacerbations and improving asthma management during pregnancy, subsequently impacting perinatal health.

  12. Poor communication may impair optimal asthma care : a qualitative study

    NARCIS (Netherlands)

    Moffat, Mandy; Cleland, Jennifer; van der Molen, Thys; Price, David

    2007-01-01

    Background. Despite asthma being primarily managed in general practice and primary care, there is little research into the issues and tools which may impact on managing poorly controlled asthma in this setting. Objective. To explore the views of health care professionals (HCPs) towards asthma guidel

  13. Manejo da asma aguda em adultos na sala de emergência: evidências atuais Management of acute asthma in adults in the emergency room: current evidence

    Directory of Open Access Journals (Sweden)

    Paulo de Tarso Roth Dalcin

    2009-01-01

    Full Text Available Asma é uma doença com uma alta prevalência em nosso meio e ao redor do mundo. Embora novas opções terapêuticas tenham sido recentemente desenvolvidas, parece haver um aumento mundial na sua morbidade e mortalidade. Em muitas instituições, as exacerbações asmáticas ainda se constituem em uma emergência médica muito comum. As evidências têm demonstrado que o manejo da asma aguda na sala de emergência concentra decisões cruciais que podem determinar o desfecho desta situação clínica. Nesta revisão, enfocaremos a avaliação e o tratamento do paciente com asma aguda na sala de emergência, descrevendo uma estratégia apropriada para o seu manejo. Serão consideradas as seguintes etapas: diagnóstico, avaliação da gravidade, tratamento, avaliação das complicações, decisão sobre onde se realizará o tratamento adicional e orientações por ocasião da alta da emergência. Espera-se que estas recomendações contribuam para que o médico clínico tome as decisões apropriadas durante o manejo da asma aguda na sala de emergência.Asthma is a disease with high prevalence in our country and worldwide. Although new therapeutic approaches have been developed recently, there seems to be a global increase in morbidity and mortality from asthma. In many institutions, asthma exacerbation is still a common medical emergency. Clinical evidence demonstrates that management of acute asthma in the emergency room entails crucial decisions that could determine the clinical outcome. In this review, the authors focus on assessment and treatment of patients with acute asthma and outline an appropriate management strategy. Diagnosis, severity assessment, treatment, complications, decision about where additional treatment will take place and orientations on discharge from the emergency will be considered. It is expected that these recommendations will help physicians to make the appropriate decisions about care of acute asthma in the emergency

  14. Legal Opportunities for Public Participation in Forest Management in the Republic of Korea

    Directory of Open Access Journals (Sweden)

    Mi Sun Park

    2016-04-01

    Full Text Available Participation by multiple actors has been emphasized in managing state forests to meet various demands on forests within a global society. Public participation was also suggested as an approach to sustainable forest management. This paper aims to investigate the legal opportunities of public participation in managing state forests in the case of the Republic of Korea (ROK. Relevant legal and policy documents were selected for content analysis and were analyzed with the levels of participation. Litigation regarding state forest conflicts was analyzed. The ROK legal system includes multiple levels of participation in managing state forests: information sharing, consultation, collaborative decision-making, and implementation. The research results indicate that various stakeholders need legal opportunities to participate in the formation and implementation of policies for the management of state forests. Regulatory enforcement is required for guaranteeing environmental rights—access to information, participation in decision-making, and standing in court. Based on research results, this paper provides us with legal insights on promoting public participation in managing state forests.

  15. Studies on provoked asthma

    International Nuclear Information System (INIS)

    A group of adult patients with perennial bronchial asthma has been studied as to lung perfusion and alveolar ventilation (81m-Kr) at rest and after provocation of an acute attack. Asthma was provoked by exercise and by histamine inhalation. After provocation the peak expiratory flow values were reduced to less than 80% of the base line values. Perfusion was often deranged. Regional ventilation changed rapidly after provocation and not always in the same fashion after exercise and histamine. During attacks lung volume increased. The expansion decreased (in parallel with increased peak expiratory flow) after inhalator of a #betta#-2 agonist (terbutaline). 81m-Kr offers unique opportunities for studying acute regional changes in alveolar ventilation. (Author)

  16. Advances in asthma 2015: Across the lifespan.

    Science.gov (United States)

    Liu, Andrew H; Anderson, William C; Dutmer, Cullen M; Searing, Daniel A; Szefler, Stanley J

    2016-08-01

    In 2015, progress in understanding asthma ranged from insights to asthma inception, exacerbations, and severity to advancements that will improve disease management throughout the lifespan. 2015's insights to asthma inception included how the intestinal microbiome affects asthma expression with the identification of specific gastrointestinal bacterial taxa in early infancy associated with less asthma risk, possibly by promoting regulatory immune development at a critical early age. The relevance of epigenetic mechanisms in regulating asthma-related gene expression was strengthened. Predicting and preventing exacerbations throughout life might help to reduce progressive lung function decrease and disease severity in adulthood. Although allergy has long been linked to asthma exacerbations, a mechanism through which IgE impairs rhinovirus immunity and underlies asthma exacerbations was demonstrated and improved by anti-IgE therapy (omalizumab). Other key molecular pathways underlying asthma exacerbations, such as cadherin-related family member 3 (CDHR3) and orosomucoid like 3 (ORMDL3), were elucidated. New anti-IL-5 therapeutics, mepolizumab and reslizumab, were US Food and Drug Administration approved for the treatment of patients with severe eosinophilic asthma. In a clinical trial the novel therapeutic inhaled GATA3 mRNA-specific DNAzyme attenuated early- and late-phase allergic responses to inhaled allergen. These current findings are significant steps toward addressing unmet needs in asthma prevention, severity modification, disparities, and lifespan outcomes. PMID:27497278

  17. A study on the effect of leverage on firms’ management opportunism behavior

    Directory of Open Access Journals (Sweden)

    Mehran Matinfard

    2013-10-01

    Full Text Available This paper presents an empirical investigation to study the relationship between the opportunism behavior and leverage. In this study, opportunism behavior is calculated based on discretionary accruals using the method proposed by Jones [Jones, J. J. (1991. Earnings management during import relief investigations. Journal of accounting research, 29(2, 193-228.]. In addition, the proposed study uses return on assets, return on equities, financial burden and financing for investigation. Using statistical data from Tehran Stock Exchange over the period 2006-2011, the study applies linear regression model and the results have indicated a positive and meaningful relationship between leverage and discretionary accruals, which is also called earnings management.

  18. The efficacy of a comprehensive lifestyle modification programme based on yoga in the management of bronchial asthma: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Bijlani Ramesh

    2009-07-01

    Full Text Available Abstract Background There is a substantial body of evidence on the efficacy of yoga in the management of bronchial asthma. Many studies have reported, as the effects of yoga on bronchial asthma, significant improvements in pulmonary functions, quality of life and reduction in airway hyper-reactivity, frequency of attacks and medication use. In addition, a few studies have attempted to understand the effects of yoga on exercise-induced bronchoconstriction (EIB or exercise tolerance capacity. However, none of these studies has investigated any immunological mechanisms by which yoga improves these variables in bronchial asthma. Methods The present randomized controlled trial (RCT was conducted on 57 adult subjects with mild or moderate bronchial asthma who were allocated randomly to either the yoga (intervention group (n = 29 or the wait-listed control group (n = 28. The control group received only conventional care and the yoga group received an intervention based on yoga, in addition to the conventional care. The intervention consisted of 2-wk supervised training in lifestyle modification and stress management based on yoga followed by closely monitored continuation of the practices at home for 6-wk. The outcome measures were assessed in both the groups at 0 wk (baseline, 2, 4 and 8 wk by using Generalized Linear Model (GLM repeated measures followed by post-hoc analysis. Results In the yoga group, there was a steady and progressive improvement in pulmonary function, the change being statistically significant in case of the first second of forced expiratory volume (FEV1 at 8 wk, and peak expiratory flow rate (PEFR at 2, 4 and 8 wk as compared to the corresponding baseline values. There was a significant reduction in EIB in the yoga group. However, there was no corresponding reduction in the urinary prostaglandin D2 metabolite (11β prostaglandin F2α levels in response to the exercise challenge. There was also no significant change in serum

  19. Effect of gender on hospital admissions for asthma and prevalence of self-reported asthma

    DEFF Research Database (Denmark)

    Prescott, E; Lange, P; Vestbo, J

    1997-01-01

    . RESULTS: At baseline 315 subjects (2.3%) reported asthma, 2.2% of women and 2.5% of men. During follow up 160 subjects were admitted to hospital for asthma. After controlling for self-reported asthma and smoking, women had a higher risk of being admitted to hospital than men (relative risk 1.7, 95......% confidence interval 1.2 to 2.4). This increased risk was not due to misclassification of chronic obstructive pulmonary disease (COPD) as asthma. CONCLUSIONS: These findings indicate gender-related differences in either the severity, perception, or management of asthma....

  20. Tiotropium – what role in asthma?

    Science.gov (United States)

    2015-09-01

    Tiotropium solution for inhalation (Spiriva Respimat - Boehringer Ingelheim) is the first long-acting muscarinic antagonist to be marketed in the UK for the management of asthma. It is licensed as add-on maintenance bronchodilator treatment in adults with asthma who are using an inhaled corticosteroid (≥800μg budesonide/day or equivalent) and a long-acting beta2 agonist, and who have had one or more severe exacerbations in the previous year. This corresponds to use at step 4 of both the British asthma guideline and the Global Initiative for Asthma (GINA) strategy for the treatment of asthma in adults. Here we consider the evidence for tiotropium in the management of asthma and whether it offers any advantages over existing therapeutic options at step 4.

  1. Is Rural School-aged Children's Quality of Life Affected by Their Responses to Asthma?

    OpenAIRE

    Horner, Sharon D.; Brown, Sharon A.; Walker, Veronica García

    2011-01-01

    The unpredictable nature of asthma makes it stressful for children and can affect their quality of life. An exploratory analysis of 183 rural school-aged children's data was conducted to determine relationships among demographic factors, children's responses to asthma (coping, asthma self-management), and their quality of life (QOL). Coping frequency, asthma severity, and race/ethnicity significantly predicted children's asthma-related QOL. Children reported more frequent coping as asthma-rel...

  2. The Role of the Primary Care Physician in Helping Adolescent and Adult Patients Improve Asthma Control

    OpenAIRE

    Yawn, Barbara P.

    2011-01-01

    Many adolescents and adults with asthma continue to have poorly controlled disease, often attributable to poor adherence to asthma therapy. Failure to adhere to recommended treatment may result from a desire to avoid regular reliance on medications, inappropriate high tolerance of asthma symptoms, failure to perceive the chronic nature of asthma, and poor inhaler technique. Primary care physicians need to find opportunities and methods to address these and other issues related to poor asthma ...

  3. Food and Beverage Management: An Introduction. Food and Beverage Management Module. Operational Management Programme. Increasing Opportunities for Supervisors and Managers.

    Science.gov (United States)

    Jones, Peter

    This self-instructional unit for supervisors and managers in the British hotel and catering industry is designed to prepare them for the more detailed units in this series, including those on food and beverage control, production, and provision. The document begins with advice on how to use the unit. Three sections cover the following topics: (1)…

  4. Bronchial asthma

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    2008049 Activation ralated genes of memory CD+4 T cells in asthma patients. PI Weifeng(皮卫峰),et al. Dept Respir Med, Xinhua Hosp, Sch Med, Shanghai Jiaotong Univ, Shanghai 200092. Chin J Tuberc Respir Dis 2007;30(12):932-935. Objective To screen and identify the genes of activated memory CD+4 T cells in asthma. Methods Differential display polymerase chain reaction(DDPCR) was utilized to identify genes of memory CD+4 T cells after activation from asthmatic patients and normal individuals,

  5. Implementation of 'matrix support' (collaborative care) to reduce asthma and COPD referrals and improve primary care management in Brazil: a pilot observational study.

    Science.gov (United States)

    Martins, Sonia Maria; Salibe-Filho, William; Tonioli, Luís Paulo; Pfingesten, Luís Eduardo; Braz, Patrícia Dias; McDonnell, Juliet; Williams, Siân; do Carmo, Débora; de Sousa, Jaime Correia; Pinnock, Hilary; Stelmach, Rafael

    2016-01-01

    Asthma and chronic obstructive pulmonary disease (COPD) are leading causes of hospitalisation and death in the city of Sao Bernardo do Campo. The municipality had difficulties in sustaining a pulmonology specialist team. Local policy has strengthened the knowledge of the primary care teams to improve the management of these diseases. Our aim is to pilot the implementation of an educational intervention based on collaborative care focused on reducing respiratory-related referrals. We implemented 'matrix support': a Brazilian collaborative educational intervention promoting specialist training and support for primary care physicians in three health territories with the highest number of referrals. Clinicians and nurses from primary care attended an 8-h workshop. The backlog of respiratory referrals was prioritised, where Asthma and COPD represented 70% of referral reasons. Initially, pulmonologists held joint consultations with physicians and nurses; as confidence grew, these were replaced by round-table note-based case discussions. The primary outcome was the number of asthma and COPD referrals. Almost all primary healthcare professionals in the three areas (132 of 157-87%) were trained; 360 patients were discussed, including 220 joint consultations. The number of respiratory referrals dropped from 290 (the year before matrix support) to 134 (the year after) (P<0.05). Referrals for asthma/COPD decreased from 13.4 to 5.4 cases per month (P=0.09) and for other lung diseases from 10.8 to 5.3 cases per month (P<0.05). Knowledge scores showed a significant improvement (P<0.001). Matrix-support collaborative care was well-accepted by primary care professionals associated with improved knowledge and reduced respiratory referrals. The initiative attracted specialists to the region overcoming historical recruitment problems. PMID:27536853

  6. Judgment skills in health literacy: Measurement and role in effective asthma patient self-management

    OpenAIRE

    Moreno Londoño, Ana Maria; Schulz, Peter J.

    2014-01-01

    This dissertation is a collection of three empirical papers describing three interrelated studies. In addition, an introductory chapter reviews the state of the art of the health literacy field and addresses how judgment skills come into play. Moreover, a general conclusion reports the contribution of this work to the field of health literacy, and states the direction for future research concerning judgment skills, and the role of these skills on the self-management of chronic diseases. Th...

  7. Workshop to launch a network on biological opportunities for GHG management, Dec 15-16, 2010, Toronto: results and recommendations

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2010-12-15

    A workshop was conducted in Toronto, Ontario on December 15 and 16, 2010 in order to launch a network on biological opportunities for management of greenhouse gases (GHGs). The workshop was sponsored by the Climate Change and Emissions Management Corporation (CCEMC) and brought together 37 persons from the Canadian climate change community. The aim was to gather leading thinkers to evaluate potential bio GHG opportunities, to determine areas for bio GHG opportunity focus and to develop a knowledge network to support investment in bio GHG opportunities. During this workshop priorities for biological work were set through the selection of bio GHG sub-wedges which require further consideration. In addition 4 potential management models were studied for the creation of an effective biological knowledge network. This workshop permitted the organisation of a knowledge network on bio GHG opportunities and it was decided in conclusion that CCEMC would lead its development.

  8. Animal models of asthma

    OpenAIRE

    Akkoç, Tunç

    2014-01-01

    ABSTRACT: Allergic disease such as asthma, rhinitis, and eczema are increasing prevelanceand affect up to 15% of population in Westernized countries. Among them, asthma is achronic inflammatory disease of airways and the underlying physiological and immunologicalprocesses are not fully understood. Mouse models of asthma dupicates many featuresof human asthma, including airway hyperreactivity, andairway inflammation. Therefore, relevantmodels for asthma are important to understand the mechanis...

  9. Childhood asthma: diagnosis and treatment.

    Science.gov (United States)

    van Aalderen, Wim M

    2012-01-01

    Many children suffer from recurrent coughing, wheezing and chest tightness. In preschool children one third of all children have these symptoms before the age of six, but only 40% of these wheezing preschoolers will continue to have asthma. In older school-aged children the majority of the children have asthma. Quality of life is affected by asthma control. Sleep disruption and exercised induced airflow limitation have a negative impact on participation in sports and social activities, and may influence family life. The goal of asthma therapy is to achieve asthma control, but only a limited number of patients are able to reach total control. This may be due to an incorrect diagnosis, co-morbidities or poor inhalation technique, but in the majority of cases non-adherence is the main reason for therapy failures. However, partnership with the parents and the child is important in order to set individually chosen goals of therapy and may be of help to improve control. Non-pharmacological measures aim at avoiding tobacco smoke, and when a child is sensitised, to avoid allergens. In pharmacological management international guidelines such as the GINA guideline and the British Guideline on the Management of Asthma are leading.

  10. Childhood Asthma: Diagnosis and Treatment

    Directory of Open Access Journals (Sweden)

    Wim M. van Aalderen

    2012-01-01

    Full Text Available Many children suffer from recurrent coughing, wheezing and chest tightness. In preschool children one third of all children have these symptoms before the age of six, but only 40% of these wheezing preschoolers will continue to have asthma. In older school-aged children the majority of the children have asthma. Quality of life is affected by asthma control. Sleep disruption and exercised induced airflow limitation have a negative impact on participation in sports and social activities, and may influence family life. The goal of asthma therapy is to achieve asthma control, but only a limited number of patients are able to reach total control. This may be due to an incorrect diagnosis, co-morbidities or poor inhalation technique, but in the majority of cases non-adherence is the main reason for therapy failures. However, partnership with the parents and the child is important in order to set individually chosen goals of therapy and may be of help to improve control. Non-pharmacological measures aim at avoiding tobacco smoke, and when a child is sensitised, to avoid allergens. In pharmacological management international guidelines such as the GINA guideline and the British Guideline on the Management of Asthma are leading.

  11. Thunderstorm asthma.

    Science.gov (United States)

    2014-10-01

    AN ASSOCIATION between asthma and thunderstorms based on retrospective data has been noted in several papers. This study, however, draws on almost-real-time, anonymised attendance data from 35 emergency departments (EDs) in the UK, and lightning-strike plots from the Met Office. PMID:25270814

  12. ENVIRONMENTAL MANAGEMENT ACCOUNTING AND THE OPPORTUNITY COST OF ENVIRONMENT MANAGEMENT SYSTEMS

    Directory of Open Access Journals (Sweden)

    ALIN EMANUEL ARTENE

    2012-05-01

    Full Text Available We all have seen the effects of the global economic and financial crisis and it becomes clearly that major changes have to occur in our economy in order to prevent a crisis in the use of the natural resources that are becoming more and more limited. This is why all types of organizations must turn their attention on the efficient use of resources that an environmental management system offers. Environmental management accounting presents a lot of information to managers within any organization mainly because it looks forward instead of looking back into the history of the firm such as traditional financial accounting does. Our objectives are to enlarge the scope and boundaries of environment management accounting so that managers can make efficient decisions in their organizations.

  13. 78 FR 16630 - Clean Air Act Grant: South Coast Air Quality Management District; Opportunity for Pubic Hearing

    Science.gov (United States)

    2013-03-18

    ... AGENCY 40 CFR Part 35 Clean Air Act Grant: South Coast Air Quality Management District; Opportunity for... Quality Management District (SCAQMD) in support of its continuing air program under section 105 of the... expenditures in the programs of the South Coast Air Quality Management District. The shortfall stems from...

  14. [Severe asthma].

    Science.gov (United States)

    González, Claudio D

    2016-01-01

    The objectives of this work were to investigate the frequency of severe asthma (SA) according to WHO definition and to compare SA patients' characteristics with those of non-severe asthma (NSA); secondly, to investigate the level of control reached throughout a period of regular treatment. Between 1-1-2005 and 12-31-2014, 471 medical records from patients with bronchial asthma assisted in Buenos Aires City were analyzed. SA frequency was 40.1% (189/471), being significantly higher among patients from the public health system (47.7%, 108/226 vs. 33%, 81/245, p = 0.001). SA patients were older than NSA ones (51.3 ± 17.4 vs. 42.6 ± 17.1 years, p = 0.000), presented longer time since onset of the disease (median 30 vs. 20 years, p = 0.000), lower educational levels (secondary level or higher 41.7% vs. 58.1%, p = 0.000), lower frequency of rhinitis (47% vs. 60.6%, p = 0.004), more severe levels of airway obstruction (FEV% 50.2 ± 13.7 vs. 77.7 ± 12.4, p = 0.000), more frequent antecedents of Near Fatal Asthma (11.1% vs. 2.8%, p = 0.000), higher levels of serum IgE (median of 410 vs. 279 UI/l, p = 0.01) and higher demand of systemic steroids requirements and hospitalizations (68.7% vs. 50.7%, p = 0.000 and 37.5% vs. 15.9%, p = 0.000, respectively). A 30.6% of SA patients (58/189) reached a follow-up period of 12 months, 13 (22.5%) of whom reached the controlled asthma level. The frequency of SA found seems to be considerable. Multicenter studies to investigate the levels of control reached by SA patients with access to proper treatment are recommended.

  15. Managing Carbon on Federal Public Lands: Opportunities and Challenges in Southwestern Colorado

    Science.gov (United States)

    Dilling, Lisa; Kelsey, Katharine C.; Fernandez, Daniel P.; Huang, Yin D.; Milford, Jana B.; Neff, Jason C.

    2016-08-01

    Federal lands in the United States have been identified as important areas where forests could be managed to enhance carbon storage and help mitigate climate change. However, there has been little work examining the context for decision making for carbon in a multiple-use public land environment, and how science can support decision making. This case study of the San Juan National Forest and the Bureau of Land Management Tres Rios Field Office in southwestern Colorado examines whether land managers in these offices have adequate tools, information, and management flexibility to practice effective carbon stewardship. To understand how carbon was distributed on the management landscape we added a newly developed carbon map for the SJNF-TRFO area based on Landsat TM texture information (Kelsey and Neff in Remote Sens 6:6407-6422. doi: 10.3390/rs6076407, 2014). We estimate that only about 22 % of the aboveground carbon in the SJNF-TRFO is in areas designated for active management, whereas about 38 % is in areas with limited management opportunities, and 29 % is in areas where natural processes should dominate. To project the effects of forest management actions on carbon storage, staff of the SJNF are expected to use the Forest Vegetation Simulator (FVS) and extensions. While identifying FVS as the best tool generally available for this purpose, the users and developers we interviewed highlighted the limitations of applying an empirically based model over long time horizons. Future research to improve information on carbon storage should focus on locations and types of vegetation where carbon management is feasible and aligns with other management priorities.

  16. Managing Carbon on Federal Public Lands: Opportunities and Challenges in Southwestern Colorado.

    Science.gov (United States)

    Dilling, Lisa; Kelsey, Katharine C; Fernandez, Daniel P; Huang, Yin D; Milford, Jana B; Neff, Jason C

    2016-08-01

    Federal lands in the United States have been identified as important areas where forests could be managed to enhance carbon storage and help mitigate climate change. However, there has been little work examining the context for decision making for carbon in a multiple-use public land environment, and how science can support decision making. This case study of the San Juan National Forest and the Bureau of Land Management Tres Rios Field Office in southwestern Colorado examines whether land managers in these offices have adequate tools, information, and management flexibility to practice effective carbon stewardship. To understand how carbon was distributed on the management landscape we added a newly developed carbon map for the SJNF-TRFO area based on Landsat TM texture information (Kelsey and Neff in Remote Sens 6:6407-6422. doi: 10.3390/rs6076407 , 2014). We estimate that only about 22 % of the aboveground carbon in the SJNF-TRFO is in areas designated for active management, whereas about 38 % is in areas with limited management opportunities, and 29 % is in areas where natural processes should dominate. To project the effects of forest management actions on carbon storage, staff of the SJNF are expected to use the Forest Vegetation Simulator (FVS) and extensions. While identifying FVS as the best tool generally available for this purpose, the users and developers we interviewed highlighted the limitations of applying an empirically based model over long time horizons. Future research to improve information on carbon storage should focus on locations and types of vegetation where carbon management is feasible and aligns with other management priorities. PMID:27272016

  17. Bronchial thermoplasty in asthma: current perspectives

    Directory of Open Access Journals (Sweden)

    Laxmanan B

    2015-05-01

    Full Text Available Balaji Laxmanan, D Kyle Hogarth Section of Pulmonary and Critical Care Medicine, University of Chicago Medicine, Chicago, IL, USA Abstract: Bronchial thermoplasty (BT is a novel therapy for patients with severe asthma. Using radio frequency thermal energy, it aims to reduce the airway smooth muscle mass. Several clinical trials have demonstrated improvements in asthma-related quality of life and a reduction in the number of exacerbations following treatment with BT. In addition, recent data has demonstrated the long-term safety of the procedure as well as sustained improvements in rates of asthma exacerbations, reduction in health care utilization, and improved quality of life. Further study is needed to elucidate the underlying mechanisms that result in these improvements. In addition, improved characterization of the asthma subphenotypes likely to exhibit the largest clinical benefit is a critical step in determining the precise role of BT in the management of severe asthma. Keywords: bronchial thermoplasty, severe asthma, airway smooth muscle

  18. Test Your Asthma Knowledge

    Science.gov (United States)

    ... Issue Past Issues Special Section Test Your Asthma Knowledge Past Issues / Fall 2007 Table of Contents For ... Asthma: A Chance to Heal / Test Your Asthma Knowledge Fall 2007 Issue: Volume 2 Number 4 Page ...

  19. Asthma triggers (image)

    Science.gov (United States)

    ... things make your asthma worse. These are called asthma "triggers". Avoiding them is your first step toward feeling better. The most common asthma triggers are mold, pets, dust, grasses, pollen, cockroaches, odors ...

  20. Allergies, asthma, and dust

    Science.gov (United States)

    Reactive airway disease - dust; Bronchial asthma - dust; Triggers - dust ... Things that make allergies or asthma worse are called triggers. Dust is a common trigger. When your asthma or allergies become worse due to dust, you are ...

  1. Allergies, asthma, and molds

    Science.gov (United States)

    Reactive airway - mold; Bronchial asthma - mold; Triggers - mold; Allergic rhinitis - pollen ... Things that make allergies or asthma worse are called triggers. Mold is a common trigger. When your asthma or allergies become worse due to mold, you are ...

  2. Asthma in Children

    Science.gov (United States)

    ... have asthma. Nearly 9 million of them are children. Children have smaller airways than adults, which makes asthma especially serious for them. Children with asthma may experience wheezing, coughing, chest tightness, ...

  3. Asthma and Food Allergies

    Science.gov (United States)

    ... Español Text Size Email Print Share Asthma and Food Allergies Page Content Article Body A family history of ... child may develop asthma . Children with asthma and food allergies are at increased risk for anaphylaxis, a severe ...

  4. Asthma Medications and Pregnancy

    Science.gov (United States)

    ... MD Medical Director, Health Initiatives View full profile Asthma and Pregnancy: Asthma Medications We would like to avoid all medicine ... make sure you are using it correctly. Other Asthma Related Medication Treatment Annual influenza vaccine (flu shot) ...

  5. Exercise-Induced Asthma

    Science.gov (United States)

    ... Melon Smoothie Pregnant? Your Baby's Growth Exercise-Induced Asthma KidsHealth > For Parents > Exercise-Induced Asthma Print A ... previous continue Tips for Kids With Exercise-Induced Asthma For the most part, kids with exercise-induced ...

  6. Management accounting and control : the diversity and opportunities in research and research methods

    OpenAIRE

    Pettersen, Inger Johanne

    2013-01-01

    This TØH-notat contains a selection of the papers presented at the workshop 6th – 8th November 2012 at Clarion hotel & Congress, Trondheim. The workshop had the following theme: Management accounting and control – the diversity and opportunities in research and research methods. The workshop was hosted and financed by HiST TØH, and is the third held by Trondheim Business School – TØH. The first one was in the mountains of Trollheimen (Storlidalen) in 2008 and the second in Trondheim 2011. ...

  7. Opportunities and challenges of integrating ecological restoration into assessment and management of contaminated ecosystems.

    Science.gov (United States)

    Hull, Ruth N; Luoma, Samuel N; Bayne, Bruce A; Iliff, John; Larkin, Daniel J; Paschke, Mark W; Victor, Sasha L; Ward, Sara E

    2016-04-01

    Ecosystem restoration planning near the beginning of the site assessment and management process ("early integration") involves consideration of restoration goals from the outset in developing solutions for contaminated ecosystems. There are limitations to integration that stem from institutional barriers, few successful precedents, and limited availability of guidance. Challenges occur in integrating expertise from various disciplines and multiple, sometimes divergent interests and goals. The more complex process can result in timing, capacity, communication, and collaboration challenges. On the other hand, integrating the 2 approaches presents new and creative opportunities. For example, integration allows early planning for expanding ecosystem services on or near contaminated lands or waters that might otherwise have been unaddressed by remediation alone. Integrated plans can explicitly pursue ecosystem services that have market value, which can add to funds for long-term monitoring and management. Early integration presents opportunities for improved and productive collaboration and coordination between ecosystem restoration and contaminant assessment and management. Examples exist where early integration facilitates liability resolution and generates positive public relations. Restoration planning and implementation before the completion of the contaminated site assessment, remediation, or management process ("early restoration") can facilitate coordination with offsite restoration options and a regional approach to restoration of contaminated environments. Integration of performance monitoring, for both remedial and restoration actions, can save resources and expand the interpretive power of results. Early integration may aid experimentation, which may be more feasible on contaminated lands than in many other situations. The potential application of concepts and tools from adaptive management is discussed as a way of avoiding pitfalls and achieving benefits in

  8. Opportunities and challenges of integrating ecological restoration into assessment and management of contaminated ecosystems.

    Science.gov (United States)

    Hull, Ruth N; Luoma, Samuel N; Bayne, Bruce A; Iliff, John; Larkin, Daniel J; Paschke, Mark W; Victor, Sasha L; Ward, Sara E

    2016-04-01

    Ecosystem restoration planning near the beginning of the site assessment and management process ("early integration") involves consideration of restoration goals from the outset in developing solutions for contaminated ecosystems. There are limitations to integration that stem from institutional barriers, few successful precedents, and limited availability of guidance. Challenges occur in integrating expertise from various disciplines and multiple, sometimes divergent interests and goals. The more complex process can result in timing, capacity, communication, and collaboration challenges. On the other hand, integrating the 2 approaches presents new and creative opportunities. For example, integration allows early planning for expanding ecosystem services on or near contaminated lands or waters that might otherwise have been unaddressed by remediation alone. Integrated plans can explicitly pursue ecosystem services that have market value, which can add to funds for long-term monitoring and management. Early integration presents opportunities for improved and productive collaboration and coordination between ecosystem restoration and contaminant assessment and management. Examples exist where early integration facilitates liability resolution and generates positive public relations. Restoration planning and implementation before the completion of the contaminated site assessment, remediation, or management process ("early restoration") can facilitate coordination with offsite restoration options and a regional approach to restoration of contaminated environments. Integration of performance monitoring, for both remedial and restoration actions, can save resources and expand the interpretive power of results. Early integration may aid experimentation, which may be more feasible on contaminated lands than in many other situations. The potential application of concepts and tools from adaptive management is discussed as a way of avoiding pitfalls and achieving benefits in

  9. Asthma morbidity and treatment in children with sickle cell disease

    OpenAIRE

    Anim, Samuel O; Strunk, Robert C.; DeBaun, Michael R.

    2011-01-01

    Children with sickle cell disease (SCD) and a comorbid condition of asthma have increased numbers of vaso-occlusive pain and acute chest syndrome episodes, and all-cause mortality. When assessed systematically, asthma prevalence is probably similar among children with SCD when compared with the general African–American population. With increasing recognition of the importance of asthma in the management of SCD, hematologists must become familiar with asthma and develop a multidisciplinary app...

  10. Family-based association analysis of beta(2)-adrenergic receptor polymorphisms in the Childhood Asthma Management Program

    NARCIS (Netherlands)

    Silverman, EK; Kwiatkowski, DJ; Sylvia, JS; Lazarus, R; Drazen, JM; Lange, C; Laird, NM; Weiss, ST

    2003-01-01

    Background: beta(2)-Adrenergic receptor (B2AR) polymorphisms have been associated with a variety of asthma-related phenotypes, but association results have been inconsistent across different studies. Objective: We sought to apply family-based association methods to individual single nucleotide polym

  11. Opportunities for international cooperation in nuclear accident preparedness and management: Procedural and organizational measures

    International Nuclear Information System (INIS)

    In this paper we address a difficult problem: How can we create and maintain preparedness for nuclear accidents? Our research has shown that this can be broken down into two questions: (1) How can we maintain the resources and expertise necessary to manage an accident once it occurs? and (2) How can we develop plans that will help in actually managing an accident once it occurs? It is apparently beyond the means of ordinary human organizations to maintain the capability to respond to a rare event. (A rare event is defined as something like an accident that only happens once every five years or so, somewhere in the world.) Other more immediate pressures tend to capture the resources that should, in a cost/benefit sense, be devoted to maintaining the capability. This paper demonstrates that some of the important factors behind that phenomenon can be mitigated by an international body that promotes and enforces preparedness. Therefore this problem provides a unique opportunity for international cooperation: an international organization promoting and enforcing preparedness could help save us from our own organizational failings. Developing useful accident management plans can be viewed as a human performance problem. It can be restated: how can we support and off-load the accident managers so that their tasks are more feasible? This question reveals the decision analytic perspective of this paper. That is, we look at the problem managing a nuclear accident by focusing on the decision makers, the accident managers: how do we create a decision frame for the accident managers to best help them manage? The decision frame is outlined and discussed. 9 refs

  12. China's soil and groundwater management challenges: Lessons from the UK's experience and opportunities for China.

    Science.gov (United States)

    Coulon, Frédéric; Jones, Kevin; Li, Hong; Hu, Qing; Gao, Jingyang; Li, Fasheng; Chen, Mengfang; Zhu, Yong-Guan; Liu, Rongxia; Liu, Ming; Canning, Kate; Harries, Nicola; Bardos, Paul; Nathanail, Paul; Sweeney, Rob; Middleton, David; Charnley, Maggie; Randall, Jeremy; Richell, Martin; Howard, Trevor; Martin, Ian; Spooner, Simon; Weeks, Jason; Cave, Mark; Yu, Fang; Zhang, Fang; Jiang, Ying; Longhurst, Phil; Prpich, George; Bewley, Richard; Abra, Jonathan; Pollard, Simon

    2016-05-01

    There are a number of specific opportunities for UK and China to work together on contaminated land management issues as China lacks comprehensive and systematic planning for sustainable risk based land management, encompassing both contaminated soil and groundwater and recycling and reuse of soil. It also lacks comprehensive risk assessment systems, structures to support risk management decision making, processes for verification of remediation outcome, systems for record keeping and preservation and integration of contamination issues into land use planning, along with procedures for ensuring effective health and safety considerations during remediation projects, and effective evaluation of costs versus benefits and overall sustainability. A consequence of the absence of these overarching frameworks has been that remediation takes place on an ad hoc basis. At a specific site management level, China lacks capabilities in site investigation and consequent risk assessment systems, in particular related to conceptual modelling and risk evaluation. There is also a lack of shared experience of practical deployment of remediation technologies in China, analogous to the situation before the establishment of the independent, non-profit organisation CL:AIRE (Contaminated Land: Applications In Real Environments) in 1999 in the UK. Many local technology developments are at lab-scale or pilot-scale stage without being widely put into use. Therefore, a shared endeavour is needed to promote the development of technically and scientifically sound land management as well as soil and human health protection to improve the sustainability of the rapid urbanisation in China. PMID:26970591

  13. Prognostics and Health Management of Wind Turbines: Current Status and Future Opportunities

    Energy Technology Data Exchange (ETDEWEB)

    Sheng, Shuangwen

    2015-12-14

    Prognostics and health management is not a new concept. It has been used in relatively mature industries, such as aviation and electronics, to help improve operation and maintenance (O&M) practices. In the wind industry, prognostics and health management is relatively new. The level for both wind industry applications and research and development (R&D) has increased in recent years because of its potential for reducing O&M cost of wind power, especially for turbines installed offshore. The majority of wind industry application efforts has been focused on diagnosis based on various sensing and feature extraction techniques. For R&D, activities are being conducted in almost all areas of a typical prognostics and health management framework (i.e., sensing, data collection, feature extraction, diagnosis, prognosis, and maintenance scheduling). This presentation provides an overview of the current status of wind turbine prognostics and health management that focuses on drivetrain condition monitoring through vibration, oil debris, and oil condition analysis techniques. It also discusses turbine component health diagnosis through data mining and modeling based on supervisory control and data acquisition system data. Finally, it provides a brief survey of R&D activities for wind turbine prognostics and health management, along with future opportunities.

  14. Rights and Responsibilities. Supervisory Skills Module. Operational Management Programme. Increasing Opportunities for Supervisors and Managers.

    Science.gov (United States)

    Martin, Rodney

    This self-instructional unit for supervisors and managers in the British hotel and catering industry is designed to consolidate the work covered in a 1-day course. The document begins with an introduction and advice on how to use the unit. The following topics are covered: (1) the law and personnel procedures; (2) consultation and negotiation; (3)…

  15. My Child is Diagnosed with Asthma, Now What? Motivating Parents to Help Their Children Control Asthma

    OpenAIRE

    Stepney, Cesalie; Kane, Katelyn; Bruzzese, Jean-Marie

    2011-01-01

    Pediatric asthma is often undiagnosed, and therefore untreated. It negatively impacts children’s functioning, including school attendance and performance, as well as quality of life. School-wide screening for asthma is becoming increasingly common, making identification of possible asthma particularly relevant for school nurses. Nurses may need to help parents cope with the new diagnosis, and teach them skills to manage the illness. The aim of this paper is to present a three-phase model of h...

  16. Asthma and Allergy Foundation of America

    Science.gov (United States)

    ... Researchers & Academics Sponsors & Supporters Donate Contact AAFA Asthma Asthma Triggers Allergens and Allergic Asthma Tobacco Smoke Air Pollution ... Feed Subscribe Asthma Capitals Asthma Facts Asthma Research Asthma Triggers Allergy Capitals Allergy Facts Allergy Research Allergy Treatment ...

  17. Randomized controlled study of CBT in bronchial asthma

    Directory of Open Access Journals (Sweden)

    Grover Naveen

    2007-01-01

    Full Text Available The aim of the present study was to find out efficacy of cognitive behavior therapy, as an adjunct to standard pharmacotherapy, in bronchial asthma. In a random-ized two-group design with pre-and post assessments, forty asthma patients were randomly allotted to two groups: self management group and cognitive behavior therapy group. Both groups were exposed to 6-8 weeks of intervention, asthma self management program and cognitive behavior therapy. Assessment measures used were-Semi structured interview schedule, Asthma Symptom Checklist, Asthma di-ary, Asthma Bother Profile, Hospital Anxiety & Depression Scale, AQLQ and Peak Expiratory Flow Rate. Within group comparison showed significant improvement in both groups at the post assessment. Between group comparisons showed that CBT group reported significantly greater change than that of SM group. Cognitive behavior therapy helps in improving the managment of asthma.

  18. Building evidence for peer-led interventions: assessing the cost of the Adolescent Asthma Action program in Australia.

    Science.gov (United States)

    Otim, Michael E; Jayasinha, Ranmalie; Forbes, Hayley; Shah, Smita

    2015-01-01

    Asthma is the most common chronic illness among adolescents in Australia. Aboriginal and Torres Strait Islander adolescents, in particular, face substantial inequalities in asthma-related outcomes. Triple A (Adolescent Asthma Action) is a peer-led education intervention, which aims to improve asthma self-management and reduce the uptake of smoking among adolescents. The aim of this study was to determine the cost of implementing the Triple A program in Australia. Standard economic costing methods were used. It involved identifying the resources that were utilised (such as personnel and program materials), measuring them and then valuing them. We later performed sensitivity analysis so as to identify the cost drivers and a stress test to test how the intervention can perform when some inputs are lacking. Results indicate that the estimated cost of implementing the Triple A program in five schools was $41060, assuming that the opportunity cost of all the participants and venues was accounted for. This translated to $8212 per school or $50 per target student. From sensitivity analysis and a stress test, it was identified that the cost of the intervention (in practice) was $14 per student. This appears to be a modest cost, given the burden of asthma. In conclusion, the Triple A program is an affordable intervention to implement in high schools. The potential asthma cost savings due to the program are significant. If the Triple A program is implemented nation-wide, the benefits would be substantial. PMID:25230153

  19. Role of leukotrienes in asthma pathophysiology

    DEFF Research Database (Denmark)

    Bisgaard, H

    2000-01-01

    Inflammation is an essential component of asthma pathophysiology. While beta(2)-agonists are often used for short-term relief of acute bronchospasm, anti-inflammatory agents are required for the long-term management of chronic inflammation in this disease. Corticosteroids have emerged as the first......-line anti-inflammatory therapy for asthma management. However, in some patients, especially children, the high doses of corticosteroids that may be required to control features of hyperresponsiveness, including exercise-induced asthma, raise safety concerns. Thus, there is a need for complementary anti......-inflammatory, steroid-sparing agents in asthma therapy. Several inflammatory mediators have been targeted in an attempt to thwart this inflammatory process, but so far with little success. The cysteinyl leukotrienes (CysLT), LTC(4), LTD(4), and LTE(4), have been shown to be essential mediators in asthma, making them...

  20. Breathing exercises for adults with asthma.

    Science.gov (United States)

    2015-11-01

    Asthma is a common long-term condition that remains poorly controlled in many people despite the availability of pharmacological interventions, evidence-based treatment guidelines and care pathways.(1) There is considerable public interest in the use of non-pharmacological approaches for the treatment of asthma.(2) A survey of people with asthma reported that many have used complementary and alternative medicine, often without the knowledge of their clinical team.(3) Such interventions include breathing techniques, herbal products, homeopathy and acupuncture. The role of breathing exercises within the management of asthma has been controversial, partly because early claims of effectiveness were exaggerated.(4) UK national guidance and international guidelines on the management of asthma have included the option of breathing exercise programmes as an adjuvant to pharmacological treatment.(5,6) Here we discuss the types of breathing exercises used and review the evidence for their effectiveness. PMID:26563876

  1. Strategic marketing management for health management: cross impact matrix and TOWS (threats, opportunities, weaknesses, strengths).

    Science.gov (United States)

    Proctor, T

    2000-01-01

    Organisations operate within a three-tiered environment--internal, micro and macro. The environment is a powerful force acting upon the effectiveness of strategic decision making. Failure to take cognisance of the influence of the three-tiered environment can have disastrous consequences. The cross-impact matrix and the TOWS matrix are two strategic decision-making aids that improve effective decision making. When used in conjunction with creative problem solving methods they can provide the basis of a powerful management tool.

  2. Retrospective Observations on the Ability to Diagnose and Manage Patients with Asthma through the Use of Impulse Oscillometry: Comparison with Spirometry and Overview of the Literature

    OpenAIRE

    Constantine Saadeh; Blake Cross; Charles Saadeh; Michael Gaylor

    2014-01-01

    Objective. Impulse oscillometry (IOS) is an evolving technology for the diagnosis and followup of patients with asthma. Our objective is to review the findings on patients who underwent both spirometry and IOS during clinical evaluations of their asthma. The goal was to retrospectively evaluate IOS during the initial diagnosis and followup of patients with asthma in comparison with spirometry. Methods. We routinely perform IOS and spirometry evaluation in patients with suspected asthma during...

  3. Management Features of Asthma in Children Under the Deletion Polymorphism of Genes Gstt1 and Gstm1

    Directory of Open Access Journals (Sweden)

    Elena C. Koloskova

    2015-03-01

    Full Text Available It has been performed complex examination of 50 school-aged children with bronchial asthma, which included a study of acetylation phenotype and a determination of deletions in the genes of glutathione-S-transferase (GSTM1 and GSTT1. The study has shown that in children with slow acetylation phenotype and the absence of deletions in genes GSTT1 and GSTM1 аssociates with poor control of the disease that requires increased anti-inflammatory therapy with an emphasis on higher "step". When using the ACT test for the assessment of asthma control often determined by the underestimation of their child's condition, indicating that about the need for the objectification of control of the disease with the help of spirographic method and subsequent correction of the basic therapy.

  4. Mechanical ventilation for severe asthma.

    Science.gov (United States)

    Leatherman, James

    2015-06-01

    Acute exacerbations of asthma can lead to respiratory failure requiring ventilatory assistance. Noninvasive ventilation may prevent the need for endotracheal intubation in selected patients. For patients who are intubated and undergo mechanical ventilation, a strategy that prioritizes avoidance of ventilator-related complications over correction of hypercapnia was first proposed 30 years ago and has become the preferred approach. Excessive pulmonary hyperinflation is a major cause of hypotension and barotrauma. An appreciation of the key determinants of hyperinflation is essential to rational ventilator management. Standard therapy for patients with asthma undergoing mechanical ventilation consists of inhaled bronchodilators, corticosteroids, and drugs used to facilitate controlled hypoventilation. Nonconventional interventions such as heliox, general anesthesia, bronchoscopy, and extracorporeal life support have also been advocated for patients with fulminant asthma but are rarely necessary. Immediate mortality for patients who are mechanically ventilated for acute severe asthma is very low and is often associated with out-of-hospital cardiorespiratory arrest before intubation. However, patients who have been intubated for severe asthma are at increased risk for death from subsequent exacerbations and must be managed accordingly in the outpatient setting. PMID:26033128

  5. Asthma and obesity

    DEFF Research Database (Denmark)

    Juel, Caroline Trunk-Black; Ali, Zarqa; Nilas, Lisbeth;

    2012-01-01

    Obesity is a major health problem, and obesity is associated with a high incidence of asthma and poor asthma control. The aim of the present paper is to systematically review the current knowledge of the effect on overall asthma control of weight reduction in overweight and obese adults with asthma....

  6. The impact of concomitant rhinitis on asthma-related quality of life and asthma control.

    OpenAIRE

    Vandenplas, O.; Dramaix, M.; Joos, G; Louis, Renaud; Michils, A; Verleden, G.; Vincken, W; Vints, A. M.; Herbots, E.; Bachert, C

    2010-01-01

    To cite this article: Vandenplas O, Dramaix M, Joos G, Louis R, Michils A, Verleden G, Vincken W, Vints A-M, Herbots E, Bachert C. The impact of concomitant rhinitis on asthma-related quality of life and asthma control. Allergy 2010; DOI: 10.1111/j.1398-9995.2010.02365.x. Abstract Background: Characterizing the interactions between the upper and lower airways is important for the management of asthma. This study aimed at assessing the specific impact of concomitant rhinitis on asthma-related ...

  7. Building Virtual Watersheds: A Global Opportunity to Strengthen Resource Management and Conservation

    Science.gov (United States)

    Benda, Lee; Miller, Daniel; Barquin, Jose; McCleary, Richard; Cai, TiJiu; Ji, Y.

    2016-03-01

    Modern land-use planning and conservation strategies at landscape to country scales worldwide require complete and accurate digital representations of river networks, encompassing all channels including the smallest headwaters. The digital river networks, integrated with widely available digital elevation models, also need to have analytical capabilities to support resource management and conservation, including attributing river segments with key stream and watershed data, characterizing topography to identify landforms, discretizing land uses at scales necessary to identify human-environment interactions, and connecting channels downstream and upstream, and to terrestrial environments. We investigate the completeness and analytical capabilities of national to regional scale digital river networks that are available in five countries: Canada, China, Russia, Spain, and United States using actual resource management and conservation projects involving 12 university, agency, and NGO organizations. In addition, we review one pan-European and one global digital river network. Based on our analysis, we conclude that the majority of the regional, national, and global scale digital river networks in our sample lack in network completeness, analytical capabilities or both. To address this limitation, we outline a general framework to build as complete as possible digital river networks and to integrate them with available digital elevation models to create robust analytical capabilities (e.g., virtual watersheds). We believe this presents a global opportunity for in-country agencies, or international players, to support creation of virtual watersheds to increase environmental problem solving, broaden access to the watershed sciences, and strengthen resource management and conservation in countries worldwide.

  8. Intent, Capability and Opportunity: A Holistic Approach to Addressing Proliferation as a Risk Management Issue

    Energy Technology Data Exchange (ETDEWEB)

    Amanda Rynes; Trond Bjornard

    2011-07-01

    Currently, proliferation risk assessment models are designed to evaluate only a portion of the overall risk, focusing exclusively on either technological or social factors to determine the extent of a threat. Many of these models are intended to act as a means of predicting proliferation potential rather than assessing the system as a whole, ignoring the ability to enhance mitigating factors and manage, rather just establish the presence of, the threat. While the information garnered through these forms of analysis is necessary, it remains incomplete. By incorporating political, social, economic and technical capabilities as well as human factors such as intent into a single, multi-faceted risk management model, proliferation risk can be evaluated more effectively. Framing this information around how to improve and expand the Regime already in place and establishing where there are gaps in the system allows for a more complete approach to risk management, mitigation and resource allocation. The research conducted here seeks to combine all three elements (intent, capability and opportunity) in a comprehensive evaluation which incorporates an assessment of state-level variables, possible proliferation pathways and technical capability. Each portion of the analysis is carried out independently then combined to illustrate the full scope of a State's nuclear infrastructure while showing areas of weakness in the institutional framework.

  9. Canadian Thoracic Society Guidelines for Occupational Asthma

    Directory of Open Access Journals (Sweden)

    Susan M Tarlo

    1998-01-01

    Full Text Available OBJECTIVE: To provide broad guidelines and principles to help primary care physicians, occupational physicians, allergists and respirologists with the recognition, diagnosis and management of patients with occupational asthma (OA.

  10. Know How to Use Your Asthma Inhaler

    Medline Plus

    Full Text Available ... Brochures Facts Triggers Indoors In the Workplace Outdoors Management Asthma Action Plan Flu Shots Inhalers Data, Statistics, ... Mixed Methods 5. Purpose Informs Design Other Evaluation Resources Multimedia ... HHS/Open USA.gov

  11. Government regulation versus market orientation in social housing management: Limitations and opportunities of European and Australian landlords

    OpenAIRE

    Nieboer, N.; Gruis, V.H.

    2005-01-01

    In the past ten to twenty years, governments in various countries have introduced or reinforced market principles in their housing systems. As a consequence, social landlords have increased opportunities to adopt a more market-oriented approach towards the management of their housing stock. Nevertheless, in many countries government regulations still have a substantial influence on the management of social rented housing. In this paper we analyse the governments influence on the management of...

  12. Comparison of early-, late-, and non-participants in a school-based asthma management program for urban high school students

    Directory of Open Access Journals (Sweden)

    Alexander Gwen

    2011-06-01

    Full Text Available Abstract Background To assess bias and generalizability of results in randomized controlled trials (RCT, investigators compare participants to non-participants or early- to late-participants. Comparisons can also inform the recruitment approach, especially when working with challenging populations, such as urban adolescents. In this paper, we describe characteristics by participant status of urban teens eligible to participate in a RCT of a school-based, web-based asthma management program. Methods The denominator for this analysis was all students found to be eligible to participate in the RCT. Data were analyzed for participants and non-participants of the RCT, as well as for students that enrolled during the initially scheduled recruitment period (early-participants and persons that delayed enrollment until the following fall when recruitment was re-opened to increase sample size (late-participants. Full Time Equivalents (FTEs of staff associated with recruitment were estimated. Results Of 1668 teens eligible for the RCT, 386 enrolled early, and 36 enrolled late, leaving 1246 non-participants. Participants were younger (p Conclusions Recruitment messages attracted youth with moderate-to-severe asthma, but extending enrollment was costly, resulting in potentially less motivated, and certainly less compliant, participants. Investigators must balance internal versus external validity in the decision to extend recruitment. Gains in sample size and external validity may be offset by the cost of additional staff time and the threat to internal validity caused by lower participant follow-up. Trial Registration ClinicalTrials.gov: NCT00201058

  13. Human health risk comparisons for environmental management baseline programs and integration opportunities (discussion draft)

    International Nuclear Information System (INIS)

    This report documents the process and results of human health risk assessments of the US Department of Energy (DOE) complex-wide programs for high-level waste, transuranic waste, low-level waste, mixed low-level waste, and spent nuclear fuel. The DOE baseline programs and alternatives for these five material types were characterized by disposition maps (system flow diagrams) and supporting information in the May 1997 report A Contractor Report to the Department of Energy on Environmental Baseline Programs and Integration Opportunities (Discussion Draft). Risk analyses were performed using the Simplified Risk Model (SRM), developed to support DOE Environmental Management (EM) integration studies. The SRM risk analyses consistently and comprehensively cover the entire programs for the five material types, from initial storage through final disposition. Risk results are presented at several levels: DOE complex-wide, material type program, individual DOE sites, and DOE site activities

  14. Carbon, energy and forest biomass: new opportunities and needs for forest management in Italy

    Directory of Open Access Journals (Sweden)

    2005-01-01

    Full Text Available Forest biomass provides a relevant fraction of world energy needs, not only in developing Countries. In Italy, several factors are presently contributing to a new interest for this resource, ranging from regulatory quotas for renewables to the increasing price of fossil fuel to the emergence of a European carbon stock exchange. This focus on renewable resources constitutes an important opportunity for the forest sector and for society by and large, but because of the potential dimensions of the emerging market it also requires new planning instruments, in order to avoid a sudden and widespread resumption of coppice management and a reduction of standing carbon stock in forest ecosystems, which would run contrary to the objectives of the Kyoto Protocol. An example of the future demand for biomasses in Central Italy is presented, based on the possible use of fuelwood in new coal-fired power plants by the 'co-firing' technology.

  15. Behavioral consequences of illness: childhood asthma as a model.

    Science.gov (United States)

    Creer, T L; Stein, R E; Rappaport, L; Lewis, C

    1992-11-01

    Several areas of research on childhood asthma are discussed within a transactional model of asthma. The model emphasizes the multidirectional influences that affect the severity of asthma and associated behavioral disability. The initial focus is on how the clinical presentation and morbidity of asthma are affected both by somatic predisposition and by interactions with multiple internal and external elements. Specific elements include emotional factors, neuroimmunology, temperament, and medication side effects. Second, the impact of asthma on the child, his or her family, and segments of the community are described, as are consequences of the disorder on quality of life. Third, there is a synopsis of preventative interventions for reducing the medical and behavioral impact of childhood asthma. The motif is that the interaction of medical and behavioral procedures can improve the management of asthma while consequences of the disorder are mollified. Finally, as examples of a transactional model of asthma, self-management programs for teaching children to become partners with their physicians in establishing and maintaining control over the disorder are described. A representative of self-management--the ACT (Asthma Care Training) program--is described, along with the impact such programs have on children, their families, and institutions. The conclusion emphasizes that asthma is a complicated and unpredictable disorder that puzzles physicians, behavioral scientists, and patients. Although new treatments may be over the horizon, controlling childhood asthma and its consequences currently rests on the cooperation and increased interaction of medical and behavioral scientists. PMID:1437411

  16. Imaging of Asthma.

    Science.gov (United States)

    Richards, John Caleb; Lynch, David; Koelsch, Tilman; Dyer, Debra

    2016-08-01

    Asthma is one of the most common diseases of the lung. Asthma manifests with common, although often subjective and nonspecific, imaging features at radiography and high-resolution computed tomography. The primary role of imaging is not to make a diagnosis of asthma but to identify complications, such as allergic bronchopulmonary aspergillosis, or mimics of asthma, such as hypersensitivity pneumonitis. This article reviews the imaging features of asthma as well as common complications and mimics. PMID:27401624

  17. The Impact of Nationally Coordinated Pharmacy-Based Asthma Education Intervention

    OpenAIRE

    Shelley Anne Diamond; Kenneth Ross Chapman

    2001-01-01

    OBJECTIVE: To assess the impact of a nationally coordinated pharmacy-based educational intervention on self-management behaviour and markers of asthma control in self-referred patients with asthma.DESIGN: An asthma clinic day was set up by a national chain of community pharmacies whereby pharmacists used a structured questionnaire to assess asthma control and self-care among self-referred patients with doctor-diagnosed asthma. In a one-on-one counselling session, each patient's educational ne...

  18. Food and Beverage Control. Food and Beverage Management Module. Operational Management Programme. Increasing Opportunities for Supervisors and Managers.

    Science.gov (United States)

    Jones, Peter

    This self-instructional unit for supervisors and managers in the British hotel and catering industry is intended to consolidate work covered in a 1-day course. The unit covers the key management functions needed to implement an effective purchasing and supply policy. The document begins with an introduction and advice on how to use the unit. The…

  19. Improving asthma severity and control screening in a primary care pediatric practice

    OpenAIRE

    Sudhanthar, Sathyanarayan; Thakur, Kripa; Sigal, Yakov; Turner, Jane; Gold, Jonathan

    2016-01-01

    Asthma is the most commonly encountered chronic disease in children. Periodic assessment of asthma severity and control is an integral part of asthma management, but patients with uncontrolled asthma don't always schedule routine asthma care visits. The aim of this project was to improve asthma control and severity screening in a primary care setting by using a validated tool for all visits for patients with a diagnosis of asthma aged 4-21 years. Our QI team developed a protocol to administer...

  20. Communicating About Smoke from Wildland Fire: Challenges and Opportunities for Managers

    Science.gov (United States)

    Olsen, Christine S.; Mazzotta, Danielle K.; Toman, Eric; Fischer, A. Paige

    2014-09-01

    Wildland fire and associated management efforts are dominant topics in natural resource fields. Smoke from fires can be a nuisance and pose serious health risks and aggravate pre-existing health conditions. When it results in reduced visibility near roadways, smoke can also pose hazardous driving conditions and reduce the scenic value of vistas. Communicating about smoke, whether in the preparation phases before a planned burn or during a wildfire event, can enable those at risk to make informed decisions to minimize their exposure to smoke or choose alternate activities that mitigate smoke completely. To date, very little research has been completed on the social aspects of smoke, such as communication or public perceptions. Here, we present findings from an exploratory study that examined challenges and opportunities related to communication (within agencies or to the public) for management of smoke from wildland fires. Interviews were conducted in California, Oregon, Montana, and South Carolina among a purposive sample of individuals, who are involved in fire or smoke management. Findings indicate that smoke poses several challenges to management agencies. Findings also provide insight into potential strategies to address such challenges by improving communication in both inter- and intra-agency situations as well as with members of the public. In particular, prioritizing fire and smoke-related communication within agencies, allocating agency resources specifically for training in communication and outreach endeavors, taking advantage of existing resources including informal social networks among the public, and building long-term relationships both between agencies and with the public were viewed as effective.

  1. Assessment of problematic severe asthma in children

    DEFF Research Database (Denmark)

    Carlsen, K. C. L.; Hedlin, G.; Bush, A.;

    2011-01-01

    Assessment of problematic severe asthma in children should be performed in a stepwise manner to ensure an optimal approach. A four-step assessment scheme is proposed. First, a full diagnostic work-up is performed to exclude other diseases which mimic asthma. Secondly, a multi-disciplinary assessm......Assessment of problematic severe asthma in children should be performed in a stepwise manner to ensure an optimal approach. A four-step assessment scheme is proposed. First, a full diagnostic work-up is performed to exclude other diseases which mimic asthma. Secondly, a multi...... in our current knowledge in all these steps are highlighted, and recommendations for current clinical practice and future research are made. The lack of good data and the heterogeneity of problematic severe asthma still limit our ability to optimise the management on an individual basis in this small...

  2. Predicting asthma control: the role of psychological triggers.

    Science.gov (United States)

    Ritz, Thomas; Bobb, Carol; Griffiths, Chris

    2014-01-01

    Asthma triggers have been linked to adverse health outcomes in asthma, but little is known about their association with asthma control. Because trigger avoidance is an integral part of successful asthma management, psychological triggers in particular may be associated with suboptimal asthma control, given the difficulty of controlling them. We examined cross-sectional and longitudinal associations of perceived asthma triggers with self-report of asthma control impairment, symptoms, and spirometric lung function (forced expiratory volume in the 1st second, [FEV1]) in 179 adult primary care asthma patients. Perceived asthma triggers explained up to 42.5% of the variance in asthma control and symptoms, but not in FEV1 alone. Allergic triggers explained up to 12.1% of the asthma control and symptom variance, three nonallergic trigger types, air pollution/irritants, physical activity, and infection, explained up to 26.2% over and above allergic triggers, and psychological triggers up to 9.5% over and above all other triggers. Psychological triggers alone explained up to 33.9% of the variance and were the only trigger class that was consistently significant in all final multiple regression models predicting control and symptoms. Psychological triggers also predicted lower asthma control 3-6 months later, although controlling for initial asthma control eliminated this association. In free reports of individually relevant triggers, only psychological triggers were associated with suboptimal asthma control. Trigger factors are important predictors of self-reported asthma control and symptoms but not actual lung function. Particular attention should be directed to psychological triggers as indicators of patients' perceptions of suboptimal asthma control.

  3. Benefits and opportunities for applying Integrated Management Systems (IMS) strategies in the nuclear industry

    International Nuclear Information System (INIS)

    Full text: The safe, reliable, and cost-effective operation of Nuclear Power Facilities require a vast accumulation of information - volumes of scientific research, engineering analysis, operational data, regulatory reviews and many other types of technical information - combined with a complex assortment of people with the requisite educational background, expertise and acquired insight to apply that body of knowledge safely and effectively. This paper is intended to address the changing strategies and deployment techniques of IMS by identifying and examining initiatives that have been instigated in other regulated (and non-regulated industries), analyzing the opportunities, challenges and success criteria. 'Virtually everything in business today is an undifferentiated commodity except how a company manages its information. How you manage information determines whether you win or lose.' - Bill Gates, Microsoft A number of independent studies have drawn similar conclusions as to the benefits of managing plant information: The National Institute of Standards and Technology (NIST) estimates that $15.8 billion in profits is lost in U.S. capital facilities every year. Most of these losses ($9.1 billion or 2.8% of total installed cost), are realized in the operations and maintenance phase of the asset life cycle, while $2.7 billion and $4.1 billion are realized in engineering, procurement, and construction (EPC) phases respectively. It is clear from the report that again the O/Os bear the brunt of the costs ($10.6 billion or 3.3% total installed cost) associated with poor information management (in this case interoperability) due to supply chain dynamics and duration, and that with proper incentives for their information supply chains, O/Os have the most to gain. - 45% of costs are associated with operations and maintenance information verification; - 15% of costs are associated with unnecessary operations and maintenance idle employee time; - 40%, the balance, is an

  4. Farm husbandry and badger behaviour: opportunities to manage badger to cattle transmission of Mycobacterium bovis?

    Science.gov (United States)

    Ward, A I; Judge, J; Delahay, R J

    2010-01-01

    Bovine tuberculosis (bTB) is a serious disease of cattle in the UK in terms of the economic impact on the farming industry. The disease has proven difficult to control in the cattle population and the Eurasian badger (Meles meles) is a source of infection. In recent years, there has been growing interest in the potential to employ farm husbandry and biosecurity practices to reduce bTB transmission risks. Here we review the potential routes of bTB transmission between badgers and cattle and explore the options for managing cattle and badger behaviour with a view to reducing the risks of inter-species transmission at pasture and within farm buildings. We discuss the relative merits of different cattle grazing regimes, habitat manipulations and badger latrine management in reducing the potential for badger-cattle contact at pasture. The physical exclusion of badgers from farm buildings is suggested as the simplest, and potentially most effective, method of reducing contact and opportunities for disease transmission between badgers and cattle. However, more research is required on the effectiveness, practicalities and costs of implementing such measures before specific guidance can be developed. PMID:19846226

  5. [Asthma clinical practice guidelines: advantages and pitfalls].

    Science.gov (United States)

    Plaza, Vicente; Bellido-Casado, Jesús; Alonso-Coello, Pablo; Rodrigo, Gustavo

    2009-01-01

    The Clinical Practice Guidelines on asthma have contributed towards unifying concepts and reaching a consensus on performances between different professional groups. However, they have failed in the overall improvement in the management of asthma, the final objective that they are meant to achieve. Today, almost 20 years after they appeared, the majority of asthmatic patients are still inadequately controlled, partly due to lack of follow up by doctors and the rest of health care staff who have to look after them. This lack of follow up of these recommendations is probably associated with a lack of well structured planning in their circulation and implementation. Also, although the recommendations of these guidelines agree in what is essential, they differ in other aspects, which in turn could be determining factors in clinical practice. The purpose of this article has been to establish the main differences in the recommendations that the principal clinical practice guidelines on the disease propose on the diagnosis, classification and treatment of asthma. To do this we have compared, The British Guideline on the Management of Asthma 2007, The Global Strategy for Asthma Management and Prevention/Global Initiative for Asthma 2006 (GINA), the National Prevention program for Education on Asthma (Programa Nacional de Prevención para la Educación del Asma) (NAEPP), the Spanish Guide for the Management of Asthma (Guía Española para el Manejo del Asma 2003) (GEMA) and the ALAT y SEPAR guides, Latin-America and Spain. Recommendations for the Prevention and Treatment of Asthma Exacerbation (América Latina y España. Recomendaciones para la Prevención y el Tratamiento de la Exacerbación Asmática 2008) (ALERTA).

  6. Stay away from asthma triggers

    Science.gov (United States)

    Asthma triggers - stay away from; Asthma triggers - avoiding; Reactive airway disease - triggers; Bronchial asthma - triggers ... to them. Have someone who does not have asthma cut the grass, or wear a facemask if ...

  7. Epidemiology of asthma in western Europe.

    Science.gov (United States)

    Charpin, D; Vervloet, D; Charpin, J

    1988-10-01

    Asthma deaths are uncommon, but have recently increased in some countries due to problems in the management of the disease. Morbidity rates show large variations, which can be attributed to differences in defining the disease, but also to genuine variations, with a trend towards less asthma in northern Europe. It has been suggested that allergic diseases as a whole, and asthma in particular, may exhibit an upward secular trend. Risk factors include a genetic background and environmental triggering factors. The importance of genetic factors is illustrated by family studies and by extreme prevalence rates observed in some communities. Environmental factors include rapid air pollution variations which act as a trigger for asthma attacks. However, at levels currently prevailing in western Europe, air pollutants do not induce a higher incidence of asthma. Altitude generates a gradual decrease in Dermatophagoides, thus explaining both the clinical improvement in asthmatics living in altitude and a lower prevalence of asthma in populations born and living there. Among the other aero-allergens, grass pollens plays a major role in spring, elicitating asthma attacks. Some natural allergens transformed by man (castor bean, soja) can be responsible for asthma epidemics.

  8. Exercise and asthma: an overview.

    Science.gov (United States)

    Del Giacco, Stefano R; Firinu, Davide; Bjermer, Leif; Carlsen, Kai-Håkon

    2015-01-01

    The terms 'exercise-induced asthma' (EIA) and 'exercise-induced bronchoconstriction' (EIB) are often used interchangeably to describe symptoms of asthma such as cough, wheeze, or dyspnoea provoked by vigorous physical activity. In this review, we refer to EIB as the bronchoconstrictive response and to EIA when bronchoconstriction is associated with asthma symptoms. EIB is a common occurrence for most of the asthmatic patients, but it also affects more than 10% of otherwise healthy individuals as shown by epidemiological studies. EIA and EIB have a high prevalence also in elite athletes, especially within endurance type of sports, and an athlete's asthma phenotype has been described. However, the occurrence in elite athletes shows that EIA/EIB, if correctly managed, may not impair physical activity and top sports performance. The pathogenic mechanisms of EIA/EIB classically involve both osmolar and vascular changes in the airways in addition to cooling of the airways with parasympathetic stimulation. Airways inflammation plays a fundamental role in EIA/EIB. Diagnosis and pharmacological management must be carefully performed, with particular consideration of current anti-doping regulations, when caring for athletes. Based on the demonstration that the inhaled asthma drugs do not improve performance in healthy athletes, the doping regulations are presently much less strict than previously. Some sports are at a higher asthma risk than others, probably due to a high environmental exposure while performing the sport, with swimming and chlorine exposure during swimming as one example. It is considered very important for the asthmatic child and adolescent to master EIA/EIB to be able to participate in physical activity on an equal level with their peers, and a precise early diagnosis with optimal treatment follow-up is vital in this aspect. In addition, surprising recent preliminary evidences offer new perspectives for moderate exercise as a potential therapeutic tool for

  9. Obesity and Asthma

    DEFF Research Database (Denmark)

    Juel, Caroline Trunk-Black; Ulrik, Charlotte Suppli

    2013-01-01

    Asthma is more prevalent in obese compared with normal weight subjects. Our aim has been to review current knowledge of the impact of obesity on asthma severity, asthma control, and response to therapy.Several studies have shown that overweight and obesity is associated with more severe asthma...... and impaired quality of life compared with normal weight individuals. Furthermore, obesity is associated with poorer asthma control, as assessed by asthma control questionnaires, limitations in daily activities, breathlessness and wheezing, use of rescue medication, unscheduled doctor visits, emergency...... department visits, and hospitalizations for acute asthma. Studies of the impact of a high body mass index (BMI) on response to asthma therapy have, however, revealed conflicting results. Most studies show that overweight and obesity is associated with less favorable response to asthma therapy with regard...

  10. A Holy Grail of asthma management: toward understanding how long-acting β2-adrenoceptor agonists enhance the clinical efficacy of inhaled corticosteroids

    Science.gov (United States)

    Giembycz, M A; Kaur, M; Leigh, R; Newton, R

    2007-01-01

    There is unequivocal evidence that the combination of an inhaled corticosteroid (ICS)—i.e. glucocorticoid—and an inhaled long-acting β2-adrenoceptor agonist (LABA) is superior to each component administered as a monotherapy alone in the clinical management of asthma. Moreover, Calverley and colleagues (Lancet 2003, 361: 449–456; N Engl J Med 2007, 356: 775–789) reporting for the ‘TRial of Inhaled STeroids ANd long-acting β2-agonists (TRISTAN)' and ‘TOwards a Revolution in COPD Health (TORCH)' international study groups also demonstrated the superior efficacy of LABA/ICS combination therapies over ICS alone in the clinical management of chronic obstructive pulmonary disease. This finding has been independently confirmed indicating that the therapeutic benefit of LABA/ICS combination therapies is not restricted to asthma and may be extended to other chronic inflammatory diseases of the airways. Despite the unquestionable benefit of LABA/ICS combination therapies, there is a vast gap in our understanding of how these two drugs given together deliver superior clinical efficacy. In this article, we review the history of LABA/ICS combination therapies and critically evaluate how these two classes of drugs might interact at the biochemical level to suppress pro-inflammatory responses. Understanding the molecular basis of this fundamental clinical observation is a Holy Grail of current respiratory diseases research as it could permit the rational exploitation of this effect with the development of new ‘optimized' LABA/ICS combination therapies. PMID:18071293

  11. The business opportunities evaluation in the vision of managers and the enterprise success

    Directory of Open Access Journals (Sweden)

    Solomia Andres

    2008-10-01

    Full Text Available The article present main criteria which must be full field buy the opportunities for becoming viable businesses, as well as the necessity of value these opportunities, getting out the main faze proposed for the evolution process of an business opportunity.

  12. 运动在儿童哮喘管理中的作用%Role of exercise in asthma management in children

    Institute of Scientific and Technical Information of China (English)

    程波利; 黄英

    2014-01-01

    Objective To study the role of exercise in asthma management in children and formulate exercise prescriptions for asthmatic children. Methods A total of 112 asthmatic children aged 7-14 years were randomized into control group (n=56, with medications only) and exercise group (n=56, with medications and exercise prescription) for a trial lasting for 4 months. An asthma diary was used for all children to record the morning and evening peak expiratory flow (PEF), daytime and nighttime asthma symptom score, use of short-acting beta agonists, participation in physical activity, and exercise-induced asthma symptoms. Results Of the 112 children, 5 dropped out before the trial completion. From the 13th week, PEF variation in exercise group was significantly lowered compared to that in the control group (P<0.05). Upon the completion of the trial, the daytime and nighttime symptoms score and emergency medication score were all significantly lower in the exercise group than in the control group (P<0.05). No severe adverse events occurred in the children during the trial. Conclusion Exercise for no less than 20 min, 3 days a week for 4 months is safe and beneficial for asthma control in children.%目的:了解运动在儿童哮喘管理中的作用,探讨适合我国儿童哮喘管理的初步运动处方。方法112例7~14岁哮喘患儿随机分为运动组(56例)和对照组(56例),运动组在给予药物治疗同时给予运动处方,对照组仅给予药物治疗,试验持续4个月。在入组后每日记录哮喘日记卡内容:早晚呼吸峰流、日间和夜间症状评分、β2受体激动剂使用频率、运动情况及及其过程中出现哮喘相关症状情况。结果112例研究对象中,共107例完成试验。运动组日内PEF变异率自第13周开始持续低于对照组(P<0.05);运动组日间症状评分、夜间症状评分及应急用药量均显著小于对照组(均P<0.05);试验期间未发生严重不良事

  13. Digital Construction Promotes the Innovation of Asthma Network Management Mode%数字化建设推进哮喘病网络管理模式的创新

    Institute of Scientific and Technical Information of China (English)

    吴建华; 代静; 吴俊丽; 赵芮

    2016-01-01

    目的:依据支气管哮喘(简称哮喘)专业特点,从当前数字化医院建设中存在的哮喘管理问题及需求出发,创新哮喘管理模式。方法:课题依托医院数字化的信息平台及六级病历系统,通过建立“哮喘的数字化网络管理平台”,进行医疗与管理的充分融合。结果:采用数字化网络管理模式对哮喘患者实施集中管理,定期短信提醒复诊督导及通知集中宣教,利用微信及QQ群与患者相互沟通,交流灵活,使患者可随时随地的接受健康指导、病情评估、随访提醒等,突破了空间的限制,同时提高了患者用药依从性,促进医患互动,大大提高了医护工作质量和效率,全面实现医院对慢性病管理的规范化、科学化、精细化,提高医院的管理水平。结论:改进现有的哮喘管理模式,探索一种医、护、患三方紧密联系的医疗服务模式,切实推广并落实哮喘的规范化治疗和管理,对提高哮喘的总体控制水平具有重要的意义,值得进行开展及推广。%Objective: On the basis of professional characteristics of bronchial asthma (hereafter referred to as asthma), starting from asthma management problems and demand existing in the current digital hospital construction, to innovate the asthma management mode. Methods: Relying on the digital information platform and six levels of medical record system of the hospital, through the establishment of the digital network management platform of asthma, the subject fully integrates healthcare and management. Results:With digital network management mode, centralized management of patients with asthma is implemented, subsequent visit is reminded of and propaganda and education are informed of regularly with SMS, with WeChat and QQ group patients are communicated with, the communication is flexible, so that the patients can accept health guidance, condition evaluation, follow-up reminder and

  14. Know How to Use Your Asthma Inhaler

    Medline Plus

    Full Text Available ... Asthma among Persons with Current Asthma Asthma and Obesity Percentage of People with Asthma who Smoke Insurance ... Asthma NCHS Asthma FastStats Survey Questions Resources for Health Professionals and Schools Healthcare Professionals Public Health Professionals ...

  15. Planetary opportunities in crop water management: Potential to outweigh cropland expansion

    Science.gov (United States)

    Jägermeyr, Jonas; Gerten, Dieter; Lucht, Wolfgang; Heinke, Jens

    2014-05-01

    Global available land and water resources probably cannot feed projected future human populations under current productivity levels. Moreover, the planetary boundaries of both land use change and water consumption are being approached rapidly, and at the same time competition between food production, bioenergy plantations and biodiversity conservation is increasing. Global cropland is expected to expand to meet future demands, while considerable yield gaps remain in many world regions. Yield increases in Sub-Saharan Africa, for example, are currently mainly based on expansion of arable land into currently non-agricultural areas - while small-scale irrigation and water conservancy methods are considered very promising to boost yields there. In the here presented modeling study we investigate, at global scale, to what degree different on-farm options to better manage green and blue water might contribute to a global crop yield increase under conditions of current climate and projected future climate change. We consider methods aiming for a maximization of crops' water use efficiency and an optimal use of available on-farm water (precipitation): reducing unproductive soil evaporation (vapor shift, VS), collecting surface runoff after rain events to mitigate subsequent dry-spells (rain-water harvesting, RWH), increasing irrigation efficiency, and expanding irrigated area into rain-fed cropland (based on water savings from higher efficiencies). Global yield simulations based on hypothetical scenarios of these management opportunities are performed with the LPJmL ecohydrological modeling framework driven by reanalysis data and GCM ensemble simulations. We consider a range of about 20 climate change projections to cover respective uncertainties, and we analyze the effects of increasing CO2 concentration on the crops and their water demand. Crops are represented in a process-based and dynamic way by 12 crop functional types, each for rain-fed and irrigated areas, with

  16. Food and Beverage Production. Food and Beverage Management Module. Operational Management Programme. Increasing Opportunities for Supervisors and Managers.

    Science.gov (United States)

    Jones, Peter

    This self-instructional unit for supervisors and managers in the British hotel and catering industry is intended to consolidate work covered in a 1-day course. The document begins with an introduction and advice on how to use the unit. The following topics are covered in the unit: (1) planning the menu; (2) food production systems; (3) kitchen…

  17. Food and Beverage Provision. Food and Beverage Management Module. Operational Management Programme. Increasing Opportunities for Supervisors and Managers.

    Science.gov (United States)

    Jones, Peter

    This self-instructional unit for supervisors and managers in the British hotel and catering industry is intended to consolidate work covered in a 1-day course. The unit covers the essential elements in the final stage of supplying food and drink--the point at which these items are served and sold to the customer. The document begins with an…

  18. The Research of A New Type of Asthma Management Mode—The Children Entering School Education%一种新型哮喘儿童管理教育模式—入校教育的研究

    Institute of Scientific and Technical Information of China (English)

    宁立华; 张亚京; 王鑫; 马春艳; 任静; 郝锦丽

    2012-01-01

      目的:探索一种新型哮喘儿童管理教育模式.方法:选择4所小学校,培训校医.通过问卷调查筛选出哮喘及可疑哮喘儿童,随机分为教育组及非教育组.由校医对教育组儿童、家长进行哮喘相关知识教育.对两组教育前后问卷情况进行比较.结果:教育后儿童及家长对哮喘相关知识的掌握情况较教育前明显提高(P<0.05);教育后家长选择使用吸入激素预防哮喘发作的人数由教育前的18人增加至27人,对选择吸入激素类抗哮喘药物有顾虑者由教育前的19人减至8人(P<0.05).结论:建立一种哮喘管理教育模式,在医生、校方人员、家长和患儿间建立哮喘管理伙伴关系来帮助学生控制哮喘.教育后哮喘患儿能对自己的病情做出正确判断,避免严重不良事件及突发事件的发生.对家长教育的重点应放在哮喘的一些特征性及不典型表现的知识上.教育后哮喘儿童及家长能正确判断发病先兆、评价病情严重程度,采取积极应对措施,从而减少哮喘发作次数及程度.哮喘治疗方面的教育重点是了解吸入与全身激素的差异,解除家长对吸人激素的顾虑.%  Objective:To explore a new model of education in management of asthmatic children.Methods:Children with asthma and suspected asthma by screened through questionnaire were randomly divided into education group and non-educational group. The school doctors educated for asthma related knowledge to education group,questionnaires before and after education were analyzed statistically.Results:After education,the asthma related knowledge were improved significantly in educated children and their parents.The number of parents chooseing to use inhaled corticosteroids to prevent asthma attacks increased from 18 to 27 persons,and the number of choosing to worry about corticosteroid decreased from 19 to 8 persons(P<0.05).Conclusion:To establish a education model of

  19. Asthma-related emergency department use: current perspectives.

    Science.gov (United States)

    Johnson, Laurie H; Chambers, Patricia; Dexheimer, Judith W

    2016-01-01

    Asthma is one of the most common chronic pediatric diseases. Patients with asthma often present to the emergency department for treatment for acute exacerbations. These patients may not have a primary care physician or primary care home, and thus are seeking care in the emergency department. Asthma care in the emergency department is multifaceted to treat asthma patients appropriately and provide quality care. National and international guidelines exist to help drive clinical care. Electronic and paper-based tools exist for both physicians and patients to help improve emergency, home, and preventive care. Treatment of patients with asthma should include the acute exacerbation, long-term management of controller medications, and controlling triggers in the home environment. We will address the current state of asthma research in emergency medicine in the US, and discuss some of the resources being used to help provide a medical home and improve care for patients who suffer from acute asthma exacerbations. PMID:27471415

  20. Integrated water resources management : constraints and opportunities with a focus on the Ganges and the Brahmaputra River Basins

    OpenAIRE

    Rahaman, Mizanur Muhammad

    2009-01-01

    The key aims of this thesis are to identify the constraints and opportunities of implementing the integrated water resources management (IWRM) concept at both the policy and field level. IWRM has been chosen as a focus of this study as all contemporary international conferences, summits, regional water policies and declarations promote the IWRM concept for the effective and efficient management of water resources. The thesis has two parts. The first part reviews the evolution of the IWRM...

  1. Missed opportunities in the diagnosis and management of protein energy malnutrition among children under 5 years in Wakiso district, Uganda

    OpenAIRE

    Akugizibwe, Roselyne; Kasolo, Josephine; Makubuya, Duncan B.; Damani, Ali M.

    2013-01-01

    Protein energy malnutrition (PEM) is one of the leading causes of death among children below 5 years in Uganda. It develops after acute childhood illnesses despite children having received treatment from health facilities. This study assessed knowledge and practices of health workers in the diagnosis and management of PEM, which was used to establish missed opportunities to prevent severe acute malnutrition (SAM) in its management. This was a cross sectional descriptive study that used questi...

  2. A STUDY OF NASAL EOSINOPHILIA IN ASTHMA PATIENTS

    Directory of Open Access Journals (Sweden)

    Ramachandra Prabhu

    2014-05-01

    Full Text Available INTRODUCTION: Asthma is an inflammatory, reversible and progressive disease with episodes of exacerbations. Asthma is now considered as single airway disease and hence comprehensive diagnosis, treatment and follow-up of upper and lower respiratory tract is essential. Both the Nasal and Bronchial mucosa are the elements of united airway disease and Eosinophils measured from this mucosa can be an indirect marker of Airway inflammation in asthma. Eosinophil infiltration is hallmark feature of pathogenesis of asthma which is the trigger for the chronic airway inflammation and these are raised in acute exacerbations. Hence assessing Eosinophil is evidence of serological marker for Airway inflammation (AI. Nasal Smear Eosinophils (NSE is used in asthma with Allergic Rhinitis (AR. This study Using Definition of GINA explores the utility of NSE as marker for management of Asthma. METHODS: In this study 100 patients diagnosed with bronchial asthma attending the outpatient department in KIMS were studied. The severity of asthma was assessed as per FEV1 classification- Adapted from 2007 NHLBI Guidelines for the diagnosis and treatment of Asthma Expert panel Report 3. The Statistical analysis was done with SAS 9.2, SPSS 15.0, Stata 10.1, Med Calc 9.0.1, Systat 12.0 and R environment ver.2.11.1.software. RESULTS: Asthma was more common in Females in this study with M: F ratio of 1.04 and Allergic Rhinitis was found in 55% of Asthmatics. Nasal Eosinophilia was seen in 44% in asthmatic group and 49% in Asthma with Allergic Rhinitis. Absolute Eosinophil count (AEC and Differential count (DC for Eosinophils was almost same in both groups. The Sensitivity of NSE with respect to DC is 70% and in AR group with Asthma and in Asthma group with/without AR it was 38%. Similarly the NSE with respect to AEC was 47% in AR group with Asthma whereas in Asthma group with/without AR it was 38%. CONCLUSIONS: The finding confirms that symptoms, Variable airflow Obstruction and

  3. Managing Watersheds as Couple Human-Natural Systems: A Review of Research Opportunities

    Science.gov (United States)

    Cai, X.

    2011-12-01

    evidenced by 1) institutional innovation for integrated watershed management; 2) real-world management practices involving multidisciplinary expertise; 3) growing role of economics in systems analysis; 4) enhanced research programs such as the CHNS program and Water, Sustainability and Climate (WSC) program at the US National Science Foundation (NSF). Furthermore, recent scientific and technological developments are expected to accommodate integrated watershed system analysis approaches, such as: 1) increasing availability of distributed digital datasets especially from remote sensing products (e.g. digital watersheds); 2) distributed and semi-distributed watershed hydrologic modeling; 3) enhanced hydroclimatic monitoring and forecast; 4) identified evidences of vulnerability and threshold behavior of watersheds; and 5) continuing improvements in computational and optimization algorithms. Managing watersheds as CHNS will be critical for watershed sustainability, which ensures that human societies will benefit forever from the watershed through development of harmonious relationships between human and natural systems. This presentation will provide a review of the research opportunities that take advantage of the concept of CHNS and associated scientific, technological and institutional innovations/developments.

  4. Government regulation versus market orientation in social housing management: Limitations and opportunities of European and Australian landlords

    NARCIS (Netherlands)

    Nieboer, N.; Gruis, V.H.

    2005-01-01

    In the past ten to twenty years, governments in various countries have introduced or reinforced market principles in their housing systems. As a consequence, social landlords have increased opportunities to adopt a more market-oriented approach towards the management of their housing stock. Neverthe

  5. Benefits and Barriers of Pediatric Healthcare Providers toward Using Social Media in Asthma Care

    Science.gov (United States)

    Martinasek, Mary P.; Panzera, Anthony D.; Schneider, Tali; Lindenberger, James H.; Bryant, Carol A.; McDermott, Robert J.; Couluris, Marisa

    2011-01-01

    Background: Adolescents with asthma are the least compliant age group for asthma management. Purpose: The purpose of this study was to explore attitudes, beliefs and perceptions of two pediatric physician groups towards using social media technology (SMT) to improve asthma management in adolescents. Methods: We employed in-depth interviews and a…

  6. Increasing Availability to and Ascertaining Value of Asthma Action Plans in Schools through Use of Technology and Community Collaboration

    Science.gov (United States)

    Hanson, Tabitha K.; Aleman, Martha; Hart, Lacey; Yawn, Barbara

    2013-01-01

    Background: Approximately 9% of school-aged children in the United States have asthma. Since 1997, the Asthma Action Plan (AAP) has been recommended as an asthma self-management tool for individuals with asthma. In the school setting, the use of the AAP has been primarily dependent on communication between the family and the school through a paper…

  7. Occupational and environmental lung disease: occupational asthma.

    Science.gov (United States)

    Stenton, S C

    2010-01-01

    Occupational exposures cause 10-15% of new-onset asthma in adults, and that represents a considerable health and economic burden. Exposure to many causative agents is now well controlled but workplace practices are constantly evolving and new hazards being introduced. Overall, there is no good evidence that the incidence of occupational asthma is decreasing. Evidence-based guidelines such as those published by the British Occupational Health research Foundation and Standards of Care documents should help raise awareness of the problem and improve management. Key targets include the control of occupational exposures, a high index of suspicion in any adult with new onset asthma, and early detailed investigation.

  8. Managing Urban Water: Opportunities and Limitations of the Ecosystem Services Framework

    Science.gov (United States)

    Hamel, P.; Keeler, B.; Donahue, M.; Hobbie, S. E.; Finlay, J. C.; Brauman, K. A.; Vogl, A.

    2015-12-01

    Traditionally applied to rural environments, the concept of ES is gaining traction in urban areas, overlapping with a number of existing management frameworks in engineering, policy science, political ecology, or urban planning. Given this overlap, it is legitimate to question the value added by the ES concept, either as a theoretical or practical framework. This is particularly the case for urban water management, where new paradigms in engineering and socio-hydrology are increasingly bringing a social dimension to problem solving. In this talk, I will illustrate key opportunities and limitations of the ES framework with a focus on the service of stormwater retention. Drawing from examples in the Global North and South (including Melbourne, Australia, and Cape Town, South Africa), I will show that the ES lens allows: i) an explicit linkage between beneficiaries and grey and green infrastructure, which improves visibility and credibility of techniques valuing urban nature; ii) an improved understanding of tradeoffs and synergies between services, even in regions with limited environmental or socio-economic data; and iii) the development of powerful visualization techniques, enhancing communication with a broad range of stakeholders. These strengths make ES assessments a powerful tool to raise awareness or assist urban planners in realizing their vision of green cities. However, in cities like Melbourne with high capacity and innovative governance, I will argue that the instrumental use of ES is limited and may even be detrimental; limitations of the ES framework, which include a perceived partiality and vagueness, may be used by detractors to undermine the work of urban planners envisioning a greener city. To conclude the talk, I will present the work that the Natural Capital Project is conducting on the application of the ES concept for global indicators of sustainable development, thereby supporting the monitoring and implementation of urban Sustainable

  9. A Multifactorial Weight Reduction Programme for Children with Overweight and Asthma : A Randomized Controlled Trial

    NARCIS (Netherlands)

    Willeboordse, Maartje; Kant, Kim D G van de; Tan, Frans E S; Mulkens, Sandra; Schellings, Julia; Crijns, Yvonne; Ploeg, Liesbeth van der; van Schayck, Constant P; Dompeling, Edward

    2016-01-01

    BACKGROUND: There is increasing evidence that obesity is related to asthma development and severity. However, it is largely unknown whether weight reduction can influence asthma management, especially in children. OBJECTIVE: To determine the effects of a multifactorial weight reduction intervention

  10. Opportunities for artificial intelligence application in computer- aided management of mixed waste incinerator facilities

    International Nuclear Information System (INIS)

    The Department of Energy/Oak Ridge Field Office (DOE/OR) operates a mixed waste incinerator facility at the Oak Ridge K-25 Site. It is designed for the thermal treatment of incinerable liquid, sludge, and solid waste regulated under the Toxic Substances Control Act (TSCA) and the Resource Conservation and Recovery Act (RCRA). This facility, known as the TSCA Incinerator, services seven DOE/OR installations. This incinerator was recently authorized for production operation in the United States for the processing of mixed (radioactively contaminated-chemically hazardous) wastes as regulated under TSCA and RCRA. Operation of the TSCA Incinerator is highly constrained as a result of the regulatory, institutional, technical, and resource availability requirements. These requirements impact the characteristics and disposition of incinerator residues, limits the quality of liquid and gaseous effluents, limit the characteristics and rates of waste feeds and operating conditions, and restrict the handling of the waste feed inventories. This incinerator facility presents an opportunity for applying computer technology as a technical resource for mixed waste incinerator operation to facilitate promoting and sustaining a continuous performance improvement process while demonstrating compliance. Demonstrated computer-aided management systems could be transferred to future mixed waste incinerator facilities

  11. Managing target of opportunity (ToO) observations in queue mode at Gemini Observatory

    Science.gov (United States)

    Roth, Katherine C.; Carrasco, E. Rodrigo; Miller, Bryan W.; Stephens, Andrew W.; Jørgensen, Inger; Rodgers, Bernadette

    2010-07-01

    Target of opportunity observations (ToO) are an integral part of multi-instrument queue operations at Gemini Observatory. ToOs comprise a significant fraction of the queue (20-25% of the highest ranking band) and with the advent of large survey telescopes (eg. Pan-STARRS, LSST) dedicated to searching for transient events this fraction may reasonably be expected to increase significantly in the coming years. While some important aspects of ToO execution at Gemini Observatory are managed automatically (eg. trigger alerts, data distribution), other areas such as duplications checking, scheduling and relative priority determination still require manual intervention. In order to increase efficiency and improve our commitment to ToOs and queue observing in general, these aspects need to be formalized and incorporated into improved phase 2 checking, automated queue scheduling and on-the-fly nightly plan generation software. We discuss the different flavors of ToOs supported at Gemini Observatory and how each kind is scheduled with respect to existing queue observations. We present ideas for formalizing these practices into a system of dynamical prioritization which automatically self adjusts as new ToO observations are triggered, high priority targets become endangered, and timing windows near expiration.

  12. Asthma, guides for diagnostic and handling

    International Nuclear Information System (INIS)

    The paper defines the asthma, includes topics as diagnostic, handling of the asthma, special situations as asthma and pregnancy, handling of the asthmatic patient's perioperatory and occupational asthma

  13. Paediatric asthma and obesity.

    Science.gov (United States)

    Lucas, Sean R; Platts-Mills, Thomas A E

    2006-12-01

    None of the explanations proposed for the increase in paediatric asthma have been adequate. It is becoming apparent that the cause of the increase in asthma must be multi-factorial. Increasing attention has been focused on the role of lifestyle in the development of asthma. Lifestyle changes that have occurred in children are those in diet and decreased physical activity, with obesity being the product of these changes. The increase in asthma, obesity and a sedentary lifestyle have occurred together. However, a temporal relationship between asthma, obesity and decreased physical activity has not been determined in the paediatric literature. Limited data suggest that decreased physical activity could be playing a role in the aetiology of asthma independent of obesity. Furthermore, there has been substantial research on the benefits of exercise programmes for paediatric patients with asthma. Longitudinal trials monitoring physical activity, obesity and the development of asthma are needed. PMID:17098637

  14. Allergies, asthma, and pollen

    Science.gov (United States)

    Reactive airway - pollen; Bronchial asthma - pollen; Triggers - pollen; Allergic rhinitis - pollen ... Things that make allergies or asthma worse are called triggers. It is important to know your triggers because avoiding them is your first step toward feeling better. ...

  15. Asthma - child - discharge

    Science.gov (United States)

    Pediatric asthma - discharge; Wheezing - discharge; Reactive airway disease - discharge ... Your child has asthma , which causes the airways of the lungs to swell and narrow. In the hospital, the doctors and nurses helped ...

  16. Smoking and asthma

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000504.htm Smoking and asthma To use the sharing features on ... your allergies or asthma worse are called triggers. Smoking is a trigger for many people who have ...

  17. Asthma, stress, and depression in women.

    Science.gov (United States)

    Frieri, Marianne; O'Connor, Maeve; Nassef, Mervat

    2015-01-01

    The occurrence of depression with asthma is very common, especially in women, and can influence behavioral factors, such as treatment compliance, self-assessment, and management of environmental triggers, that can collectively result in poor asthma management and control. This review describes the association and major clinical implications of stress, anxiety, and depression, and the associated hormonal changes frequently seen in women with poorly controlled asthma. Several validated instruments have recently been developed for screening patients for depression that can now be used and benefit patients with asthma by earlier detection of these confounding risk factors. The review also highlights the need for further delineation and characterization of specific underlying pathophysiologic and immunologic mechanisms responsible for depression in women.

  18. Lung penetration and patient adherence considerations in the management of asthma: role of extra-fine formulations

    Directory of Open Access Journals (Sweden)

    Scichilone N

    2013-03-01

    Full Text Available Corrigendum Scichilone N, Spatafora M, Battaglia S, Arrigo R, Benfante A, Bellia V. J Asthma Allergy. 2013;6:11–21.On page 15, the note in the legend for Figure 3 was incorrectly listed as "The improvement is greater in the extra-fine beclomethasone-formoterol combination group than in the non-extra-fine fluticasone propionate-formoterol group". The correct sentence is "The improvement is greater in the extra-fine beclomethasone-formoterol combination group than in the non-extra-fine fluticasone propionate-salmeterol group".On page 16, there is a missing note for Figure 4. Note: Data on file. (Chiesi Farmaceutici S.p.A, 2012Read the original article

  19. A job description for the effective self-management of a long-term condition: experiences of living with difficult asthma.

    Science.gov (United States)

    Deacon, Maureen; Rickards, Emma

    2013-04-01

    This paper concerns a study exploring the salience of a 'job description' for the effective self-management of a long-term condition to the experiences of a group of women living with difficult asthma. This is a life-threatening disease. It has been claimed that sufferers are a marginalised, misunderstood, mistreated and vulnerable group. The method involved secondary analysis of focus group data. The job description has been developed as a tool to enable nurses to facilitate and support effective self-management. This study was designed to examine the application of this tool to a particular case. Long-term conditions are a growing feature of the developed world and are strongly implicated in health inequalities. They are more prevalent in socially and economically disadvantaged populations and therefore add further burden to already vulnerable people. Effective self-management is critical to adapting and adjusting to the experience of a long-term condition and nurses have a responsibility to promote this process.

  20. Genetics of asthma

    DEFF Research Database (Denmark)

    Thomsen, Simon F

    2015-01-01

    Asthma runs in families, and children of asthmatic parents are at increased risk of asthma. Prediction of disease risk is pivotal for the clinician when counselling atopic families. However, this is not always an easy task bearing in mind the vast and ever-increasing knowledge about asthma genetics...... of methods and advances in asthma genetics in an attempt to help the clinician keep track of the most important knowledge in the field....

  1. Asthma in Africa

    OpenAIRE

    Emmanuel O D Addo-Yobo; Ashley Woodcock; Adorkor Allotey; Benjamin Baffoe-Bonnie; David Strachan; Adnan Custovic

    2007-01-01

    Editors' Summary Background. The proportion of children with asthma is thought to be increasing worldwide, and particularly among children that live in more developed countries. However, it is not clear why this is, since many different aspects of lifestyle and the environment have been linked with the onset of asthma. In Africa, asthma has typically been thought of as being very uncommon, and indeed in many African dialects there is no word for asthma or the symptoms, such as wheezing, that ...

  2. Obesity, Nutrition, and Asthma in Children.

    Science.gov (United States)

    Lang, Jason E

    2012-06-01

    Obesity rates have increased dramatically among children in many parts of the world, especially in North America and several other English-speaking countries. The impact of obesity on pediatric health has become a major prevention initiative by the Obama administration and several public health organizations. Children with obesity are at increased risk for developing asthma, which is already one of the most common chronic diseases among children. The cause underlying obesity's impact on asthma risk is unknown. Commonly cited potential etiologies include airway smooth muscle dysfunction from thoracic restriction, obesity-related circulating inflammation priming the lung, and obesity-related comorbidities mediating asthma symptom development. Each of these theories does not fit precisely with all of the data that have accumulated over the last decade. In this review, I will explore other possible causes including: (1) dietary characteristics common in Westernized countries that might lead to both obesity and asthma; (2) reductions in physical activity; and (3) genetic alterations that increase the propensity to both obesity and asthma together. Next, I will review the current data on how obesity affects common characteristics of asthma such as airway inflammation, lung function, risk of exacerbation, atopy, and response to treatment. Obesity in children with asthma appears to be associated with greater airflow obstruction and a mildly diminished response to inhaled corticosteroids. Little objective evidence in children suggests that obesity significantly heightens the risk of exacerbation or worsens disease stability in children. Lastly, I will discuss the current literature that suggests that obese children with asthma generally should receive the same guidelines-based management as lean children. However, interventions that encourage daily physical activity, weight-loss, normalization of nutrient levels, and monitoring of common obesity-related sequelae should be

  3. Asthma in the elderly: a different disease?

    Directory of Open Access Journals (Sweden)

    Salvatore Battaglia

    2016-03-01

    Asthma is a chronic airway disease that affects all ages, but does this definition also include the elderly? Traditionally, asthma has been considered a disease of younger age, but epidemiological studies and clinical experience support the concept that asthma is as prevalent in older age as it is in the young. With the ever-increasing elderly population worldwide, the detection and proper management of the disease in old age may have a great impact from the public health perspective. Whether asthma in the elderly maintains the same characteristics as in young populations is an interesting matter. The diagnostic process in older individuals with suspected asthma follows the same steps, namely a detailed history supported by clinical examination and laboratory investigations; however, it should be recognised that elderly patients may partially lose reversibility of airway obstruction. The correct interpretation of spirometric curves in the elderly should take into account the physiological changes in the respiratory system. Several factors contribute to delaying the diagnosis of asthma in the elderly, including the age-related impairment in perception of breathlessness. The management of asthma in advanced age is complicated by the comorbidities and polypharmacotherapy, which advocate for a comprehensive approach with a multidimensional assessment. It should be emphasised that older age frequently represents an exclusion criterion for eligibility in clinical trials, and current asthma medications have rarely been tested in elderly asthmatics. Ageing is associated with pharmacokinetic changes of the medications. As a consequence, absorption, distribution, metabolism and excretion of antiasthmatic medications can be variably affected. Similarly, drug-to-drug interactions may reduce the effectiveness of inhaled medications and increase the risk of side-effects. For this reason, we propose the term “geriatric asthma” be preferred to the more generic “asthma in the

  4. A Review of Telemedicine and Asthma

    OpenAIRE

    Claire Wainwright; Richard Wootton

    2003-01-01

    The literature contains a number of reports of early work involving telemedicine and chronic disease; however, there are comparatively few studies in asthma. Most of the telemedicine studies in asthma have investigated the use of remote monitoring of patients in the home, e.g. transmitting spirometry data via a telephone modem to a central server. The primary objective of these studies was to improve management. A secondary benefit was that patient adherence to prescribed treatment is also li...

  5. Asthma symptoms do not predict spirometry

    OpenAIRE

    Robert L Cowie; Underwood, Margot F; Field, Stephen K

    2007-01-01

    BACKGROUND: Asthma is a disease characterized by variable airflow obstruction, but the measurement of airflow is often omitted in the process of diagnosis and management of the disease.OBJECTIVES: Features of asthma severity and control were examined to determine the extent to which objective measurements, including forced expiratory volume in 1 s and forced expiratory volume in 1 s/forced vital capacity, correlated with other manifestations of the disease.METHODS: Subjects were a consecutive...

  6. Antifungals in severe asthma

    NARCIS (Netherlands)

    Parulekar, Amit D.; Diamant, Zuzana; Hanania, Nicola A.

    2015-01-01

    Purpose of review Despite guideline-based treatment, many patients with severe asthma continue to have uncontrolled disease. Fungal allergy is being increasingly recognized in the pathogenesis of severe asthma. Limited data exist on the approach to treatment of fungal asthma. This review summarizes

  7. Obesity and asthma

    DEFF Research Database (Denmark)

    Ali, Zarqa; Ulrik, Charlotte Suppli

    2013-01-01

    Epidemiological data has established increasing adiposity as a risk factor for incident asthma. However, the mechanisms underlying the association between obesity and asthma are incompletely understood. In the present paper, we review current knowledge of possible mechanisms mediating the observed...... association between obesity and asthma....

  8. Do Allergies Cause Asthma?

    Science.gov (United States)

    ... Smoothie Pregnant? Your Baby's Growth Do Allergies Cause Asthma? KidsHealth > For Parents > Do Allergies Cause Asthma? Print A A A Text Size en español ¿Causan asma las alergias? My daughter has asthma and I'm worried that her younger brother ...

  9. Classification of Asthma Based on Nonlinear Analysis of Breathing Pattern.

    Directory of Open Access Journals (Sweden)

    Mohammad Reza Raoufy

    Full Text Available Normal human breathing exhibits complex variability in both respiratory rhythm and volume. Analyzing such nonlinear fluctuations may provide clinically relevant information in patients with complex illnesses such as asthma. We compared the cycle-by-cycle fluctuations of inter-breath interval (IBI and lung volume (LV among healthy volunteers and patients with various types of asthma. Continuous respiratory datasets were collected from forty age-matched men including 10 healthy volunteers, 10 patients with controlled atopic asthma, 10 patients with uncontrolled atopic asthma, and 10 patients with uncontrolled non-atopic asthma during 60 min spontaneous breathing. Complexity of breathing pattern was quantified by calculating detrended fluctuation analysis, largest Lyapunov exponents, sample entropy, and cross-sample entropy. The IBI as well as LV fluctuations showed decreased long-range correlation, increased regularity and reduced sensitivity to initial conditions in patients with asthma, particularly in uncontrolled state. Our results also showed a strong synchronization between the IBI and LV in patients with uncontrolled asthma. Receiver operating characteristic (ROC curve analysis showed that nonlinear analysis of breathing pattern has a diagnostic value in asthma and can be used in differentiating uncontrolled from controlled and non-atopic from atopic asthma. We suggest that complexity analysis of breathing dynamics may represent a novel physiologic marker to facilitate diagnosis and management of patients with asthma. However, future studies are needed to increase the validity of the study and to improve these novel methods for better patient management.

  10. Future Research Directions in Asthma. An NHLBI Working Group Report.

    Science.gov (United States)

    Levy, Bruce D; Noel, Patricia J; Freemer, Michelle M; Cloutier, Michelle M; Georas, Steve N; Jarjour, Nizar N; Ober, Carole; Woodruff, Prescott G; Barnes, Kathleen C; Bender, Bruce G; Camargo, Carlos A; Chupp, Geoff L; Denlinger, Loren C; Fahy, John V; Fitzpatrick, Anne M; Fuhlbrigge, Anne; Gaston, Ben M; Hartert, Tina V; Kolls, Jay K; Lynch, Susan V; Moore, Wendy C; Morgan, Wayne J; Nadeau, Kari C; Ownby, Dennis R; Solway, Julian; Szefler, Stanley J; Wenzel, Sally E; Wright, Rosalind J; Smith, Robert A; Erzurum, Serpil C

    2015-12-01

    Asthma is a common chronic disease without cure. Our understanding of asthma onset, pathobiology, classification, and management has evolved substantially over the past decade; however, significant asthma-related morbidity and excess healthcare use and costs persist. To address this important clinical condition, the NHLBI convened a group of extramural investigators for an Asthma Research Strategic Planning workshop on September 18-19, 2014, to accelerate discoveries and their translation to patients. The workshop focused on (1) in utero and early-life origins of asthma, (2) the use of phenotypes and endotypes to classify disease, (3) defining disease modification, (4) disease management, and (5) implementation research. This report summarizes the workshop and produces recommendations to guide future research in asthma. PMID:26305520

  11. The research progress on family management and psychotherapy of childhood asthma%儿童哮喘家庭管理和心理治疗研究进展

    Institute of Scientific and Technical Information of China (English)

    顾希茜(综述); 向莉(审校)

    2014-01-01

    哮喘的高患病率及其反复发作、慢性持续、难以治愈的特点对哮喘儿童生理、心理及其家庭都会产生重要影响。该文一方面通过简述儿童哮喘家庭管理的研究现状及其影响因素,深入了解哮喘家庭管理的必要性;另一方面综述行为疗法、认知疗法、认知行为疗法、放松疗法、家庭心理疗法等目前国内外现有的心理治疗措施,以及上述各种心理疗法的实施效果,以期为制定儿童哮喘综合防治体系及实施研究提供思路。%The childhood asthma is characterized as high morbidity,recurrent attack,chronic persistence and refractoriness. So asthma with these features mentioned above can have important effect on children′s emo-tional and physical development as well as their families. This review sketches the studies of children asthma family management present situation and its influencing factors,and stresses the necessity of asthma family man-agement. Methods of psychotherapy used in our country and abroad and its implementation effect are reviewed, including behavior therapy,cognitive therapy,cognitive behavioral therapy,relaxation therapy,family therapy and other existing psychological treatment,in order that these measures can be conductive to the development of pre-vention methods of pediatric asthma and further researches.

  12. Near fatal asthma: treatment and prevention.

    Science.gov (United States)

    D'Amato, G; Vitale, C; Lanza, M; Sanduzzi, A; Molino, A; Mormile, M; Vatrella, A; Bilò, M B; Antonicelli, L; Bresciani, M; Micheletto, C; Vaghi, A; D'Amato, M

    2016-07-01

    Near-fatal asthma (NFA) is described as acute asthma associated with a respiratory arrest or arterial carbon dioxide tension greater than 50 mmHg, with or without altered consciousness, requiring mechanical ventilation. Risk factors for near fatal asthma have not been fully elucidated. In 80-85% of all fatal events, a phenotype, characterized by eosinophilic inflammation associated with gradual deterioration occurring in patients with severe and poorly controlled asthma, has been identified. Regarding to the management, acute severe asthma remains a significant clinical problem, which needs to be identified to facilitate early and appropriate therapeutic interventions. The assessment relies on clinical signs, but additional information might be obtained from chest radiography or blood gas analysis. No investigation should delay the initiation of appropriate therapy. The goals of therapy are the maintenance of oxygenation, relief of airflow obstruction, reduction of airways edema and mucus plugging (with Increased use of medications such as beta-agonists via metered dose inhalers and nebulizers, oral and/or intravenous (other than by inhalation) corticosteroids and oral or intravenous theophylline) whereas supporting ventilation as clinically indicated. Of course, the emergency physician needs to consider the wide range of potential complications, as attention to these problems when managing severe acute asthma might significantly improve outcome. An understanding of the available agents and potential pitfalls in the management of NFA is mandatory for the emergency physician. PMID:27425166

  13. Asthma in pregnancy: a hit for two

    Directory of Open Access Journals (Sweden)

    Vanessa E. Murphy

    2014-03-01

    Full Text Available Asthma commonly occurs in pregnant females, and recent data have outlined the risks of adverse perinatal outcomes among this population. There is an increased risk of low birth weight and small for gestational age, particularly among females with moderate-to-severe asthma and exacerbations during pregnancy. There is also an increased risk of preterm birth, especially with oral steroid use, a small but statistically significant increased risk of congenital malformations, particularly of cleft lip with or without cleft palate, and an increased risk of neonatal hospitalisation and death. Active management may reduce these risks, possibly through reductions in exacerbations. Additional reassuring data have been presented for asthma medication use, which support the benefits outweighing the risks of indicated asthma medication use in pregnancy. Viral infections are an important trigger of asthma exacerbations in pregnancy, and recent data provides possible immunological changes that may explain this. Poor medication adherence despite worsening asthma symptoms in pregnancy is a problem which continues to be demonstrated in the literature. Improving asthma control in pregnancy has the potential to improve not only the mother’s health but also that of her child.

  14. Asthma in pregnancy: a hit for two.

    Science.gov (United States)

    Murphy, Vanessa E; Schatz, Michael

    2014-03-01

    Asthma commonly occurs in pregnant females, and recent data have outlined the risks of adverse perinatal outcomes among this population. There is an increased risk of low birth weight and small for gestational age, particularly among females with moderate-to-severe asthma and exacerbations during pregnancy. There is also an increased risk of preterm birth, especially with oral steroid use, a small but statistically significant increased risk of congenital malformations, particularly of cleft lip with or without cleft palate, and an increased risk of neonatal hospitalisation and death. Active management may reduce these risks, possibly through reductions in exacerbations. Additional reassuring data have been presented for asthma medication use, which support the benefits outweighing the risks of indicated asthma medication use in pregnancy. Viral infections are an important trigger of asthma exacerbations in pregnancy, and recent data provides possible immunological changes that may explain this. Poor medication adherence despite worsening asthma symptoms in pregnancy is a problem which continues to be demonstrated in the literature. Improving asthma control in pregnancy has the potential to improve not only the mother's health but also that of her child.

  15. Factors influencing asthma control: results of a real-life prospective observational asthma inhaler treatment (ASIT study

    Directory of Open Access Journals (Sweden)

    Yıldız

    2013-07-01

    Full Text Available Füsun Yildiz, On behalf of the ASIT Study Group Department of Pulmonary Disease, Kocaeli University School of Medicine, Kocaeli, Turkey Background: Despite the availability of new pharmacological options and novel combinations of existing drug therapies, the rate of suboptimal asthma control is still high. Therefore, early identification of the clinical and behavioral factors responsible for poor asthma control, and interventions during routine outpatient visits to improve asthma trigger management, are strongly recommended. This study was designed to evaluate the profiles of asthmatic patients and their inhaler treatment devices in relation to asthma control in Turkey. Methods: A total of 572 patients with persistent asthma (mean [standard deviation] age: 42.7 [12.1] years; 76% female were included in this prospective observational study. A baseline visit (0 month, visit 1 and three follow-up visits (1, 3 and 6 months after enrolment were conducted to collect data on demographics, past medical and asthma history, and inhaler device use. Results: Asthma control was identified in 61.5% of patients at visit 1 and increased to 87.3% at visit 4 (P < 0.001, regardless of sociodemographics, asthma duration, body mass index or smoking status. The presence of asthma-related comorbidity had a significantly negative effect on asthma control (P = 0.004. A significant decrease was determined, in the rate of uncontrolled asthma, upon follow-up among patients who were using a variety of fixed dose combination inhalers (P < 0.001 for each. Logistic regression analysis was used to show that the presence of asthma-related comorbidity (odds ratio [OR], 0.602; 95% confidence interval [CI], 0.419; 0.863, P = 0.006 and active smoking (OR, 0.522; 95% CI, 0.330; 0.825, P = 0.005 were significant predictors of asthma control. Conclusion: Our findings indicate that, despite ongoing treatment, asthma control rate was 61.5% at visit 1 in adult outpatients with persistent

  16. Measurement of asthma control according to global initiative for asthma guidelines: a comparison with the asthma control questionnaire

    Directory of Open Access Journals (Sweden)

    Olaguibel José

    2012-06-01

    Full Text Available Abstract Introduction Asthma Control Questionnaire (ACQ is a validated tool to measure asthma control. Cut-off points that best discriminate “well-controlled” or “not well-controlled” asthma have been suggested from the analysis of a large randomized clinical trial but they may not be adequate for daily clinical practice. Aims To establish cut-off points of the ACQ that best discriminate the level of control according to Global Initiative for Asthma (GINA 2006 guidelines in patients with asthma managed at Allergology and Pulmonology Departments as well as Primary Care Centers in Spain. Patients and methods An epidemiological descriptive study, with prospective data collection. Asthma control following GINA-2006 classification and 7-item ACQ was assessed. The study population was split in two parts: 2/3 for finding the cut-off points (development population and 1/3 for validating the results (validation population. Results A total of 1,363 stable asthmatic patients were included (mean age 38 ± 14 years, 60.3% women; 69.1% non-smokers. Patient classification according to GINA-defined asthma control was: controlled 13.6%, partially controlled 34.2%, and uncontrolled 52.3%. The ACQ cut-off points that better agreed with GINA-defined asthma control categories were calculated using receiver operating curves (ROC. The analysis showed that ACQ  Conclusion The ACQ cut-off points associated with GINA-defined asthma control in a real-life setting were

  17. Asthma in the elderly

    OpenAIRE

    Domenico Lorenzo Urso

    2012-01-01

    As the population increases in age, the diseases of older age will have increasing prevalence and place a greater burden on the health system. Despite asthma being usually considered a disease of younger people, asthma mortality is currently greatest in the over 55 age-group. Symptoms and emergency presentations for health care due to asthma place a great burden on the quality of life of those over age 55 with asthma. Asthma in older people is under-diagnosed due to patient and physiological ...

  18. FeNO and Asthma Treatment in Children

    OpenAIRE

    Lu, Min; Wu, Beirong; Che, Datian; Qiao, Rong; Gu, Haoxiang

    2015-01-01

    Abstract Traditional asthma treatments are typically adjusted in children with asthma using symptoms and spirometry. Treatments tailored in accordance to inflammatory markers, such as fraction of exhaled nitric oxide (FeNO) or sputum eosinophils, are increasing in use. This meta-analysis evaluated the potential benefit of incorporating the use of monitoring FeNO with guideline-based management in treating children with asthma. PubMed and Cochrane CENTRAL databases were searched until November...

  19. DSM [demand-side management] opportunities in Alberta: An economist's perspective

    International Nuclear Information System (INIS)

    In Alberta, utility companies are placing increasing attention on demand-side management (DSM) as one option for meeting future demand. Some basic economic principles are provided to yield a guideline on how much a utility should be spending on DSM initiatives. For the case of financial incentives to customers, it is shown that subsidies based on sound economic principles will enable the utility to charge lower overall rates to customers receiving the subsidy without raising other customers' rates. Moving outside of a well-understood market-based system and into a fully centralized planning approach to DSM eliminates a critical link between utilities and their customers. In Alberta, DSM measures appropriate in other regions will not be appropriate due to the province's unique supply and demand characteristics. Most of Alberta's electricity supply comes from low-cost coal-fired plants. On the demand-side, there is a significant concentration of large industrial and commercial consumers, notably in the oil and gas industry, and there is essentially no demand for electric heating in homes since natural gas is very abundant. The Alberta integrated power system currently operates at a load factor of ca 77%, reflecting the large industrial demand and the absence of a winter peaking effect associated with electrical heating requirements. A relatively small difference in embedded and incremental electricity supply costs means that utilities have little to spend on DSM programs. The identification of cost-effective DSM opportunities, most of which are likely to be found in the industrial sector, requires a considerable amount of detailed information on consumer behavior and close collaboration between utility and customer

  20. Tropical montane cloud forests: current threats and opportunities for their conservation and sustainable management in Mexico.

    Science.gov (United States)

    Toledo-Aceves, Tarin; Meave, Jorge A; González-Espinosa, Mario; Ramírez-Marcial, Neptalí

    2011-03-01

    Tropical montane cloud forests (TMCF) are among the most threatened ecosystems globally in spite of their high strategic value for sustainable development due to the key role played by these forests in hydrological cycle maintenance and as reservoirs of endemic biodiversity. Resources for effective conservation and management programs are rarely sufficient, and criteria must be applied to prioritize TMCF for conservation action. This paper reports a priority analysis of the 13 main regions of TMCF distribution in Mexico, based on four criteria: (1) forest quality, (2) threats to forest permanence, (3) threats to forest integrity, and (4) opportunities for conservation. Due to the diverse socio-environmental conditions of the local communities living in Mexican TMCF regions, their associated social characteristics were also evaluated to provide a background for the planning of conservation actions. A set of indicators was defined for the measurement of each criterion. To assign priority values for subregions within each main region, an international team of 40 participants evaluated all the indicators using multicriteria decision-making analysis. This procedure enabled the identification of 15 subregions of critical priority, 17 of high priority, and 10 of medium priority; three more were not analysed due to lack of information. The evaluation revealed a number of subjects that had hitherto been undetected and that may prove useful for prioritization efforts in other regions where TMCF is similarly documented and faces equally severe threats. Based on this analysis, key recommendations are outlined to advance conservation objectives in those TMCF areas that are subjected to high pressure on forest resources.

  1. Obesity and asthma

    DEFF Research Database (Denmark)

    Sivapalan, Pradeesh; Diamant, Zuzana; Ulrik, Charlotte Suppli

    2015-01-01

    PURPOSE OF REVIEW: Obesity has significant impact on asthma incidence and manifestations. The purpose of the review is to discuss recent observations regarding the association between obesity and asthma focusing on underlying mechanisms, clinical presentation, response to therapy and effect...... of weight reduction. RECENT FINDINGS: Clinical and epidemiological studies indicate that obese patients with asthma may represent a unique phenotype, which is more difficult to control, less responsive to asthma medications and by that may have higher healthcare utilization. A number of common comorbidities...... have been linked to both obesity and asthma, and may, therefore, contribute to the obese-asthma phenotype. Furthermore, recently published studies indicate that even a modest weight reduction can improve clinical manifestations and outcome of asthma. SUMMARY: Compared with normal-weight patients, obese...

  2. Compliance and noncompliance in asthma.

    Science.gov (United States)

    Kaiser, Harold B

    2007-01-01

    Compliance and noncompliance are big issues in asthma management. It has been well established that compliant patients experience less exacerbations than less compliant patients and that compliance rates often are <50%. The reasons for noncompliance are multiple and complex and not always clearly understood. Methods proposed to improve compliance include patient education, more partnership care, less frequent dosing, simple schedules, diaries, etc. Less dosing and simple schedules are most effective. It is difficult to improve compliance overall and despite extensive research and efforts, rates of compliance remain low. Noncompliance in asthma management is a fact of life and no single compliance-improving strategy probably will be as effective as a good physician-patient relationship. PMID:18034967

  3. Insights, attitudes, and perceptions about asthma and its treatment: findings from a multinational survey of patients from Latin America

    OpenAIRE

    Maspero, Jorge F; Jardim, Jose R.; Aranda, Alvaro; Tassinari C, Paolo; Gonzalez-Diaz, Sandra N.; Sansores, Raul H; Moreno-Cantu, Jorge J; Fish, James E.

    2013-01-01

    Background In 2011 the Latin America Asthma Insight and Management (LA AIM) survey explored the realities of living with asthma. We investigated perception, knowledge, and attitudes related to asthma among Latin American asthma patients. Methods Asthma patients aged ≥12 years from four Latin American countries (Argentina, Brazil, Mexico, Venezuela) and the Commonwealth of Puerto Rico responded to questions during face-to-face interviews. A sample size of 2,169 patients (approximately 400 pati...

  4. JOB OPPORTUNITIES (SUBSURFACE PROTECTION AND REMEDIATION DIVISION, ADA, OKLAHOMA, NATIONAL RISK MANAGEMENT RESEARCH LABORATORY)

    Science.gov (United States)

    This page lists job opportunities at NRMRL's Subsurface Protection and Remediation Division (SPRD) located in Ada, Oklahoma. These include both EPA Postdoctoral Positions and National Research Council Postdoctoral Positions.SPRD's research programs include basic studies to enha...

  5. Analysis of development opportunities for the performance management process : Case: Kela, The Social Insurance Institution of Finland

    OpenAIRE

    Tolvanen, Timo

    2014-01-01

    The main objective of this thesis is to study the development opportunities for improving the performance management process with the help of Business Intelligence tools and processes in the case organization. The research questions in this study concern the present challenges of the Business Intelligence usage in the case organization. This research aims to find an answer to the question of how Business Intelligence tools and processes should be integrated and aligned to support the new perf...

  6. Small states in a global economy: The role of institutions in managing vulnerability and opportunity in small developing countries

    OpenAIRE

    Bräutigam, Deborah; Woolcock, Michael

    2001-01-01

    Small states have always been more vulnerable in the global economy. This is so because trade comprises a larger proportion of their economic activity, and because they lack the power to set the terms or make any of the rules that govern globalization. Studies of small states tend to focus on the nature of their vulnerabilities, without considering that these countries have managed external pressures in different ways. Globalization brings opportunities as well as risks, and a more integrated...

  7. NETWORK PERSPECTIVE ON STAKEHOLDER MANAGEMENT: FACILITATING ENTREPRENEURS IN THE DISCOVERY OF OPPORTUNITIES

    OpenAIRE

    W. VANDEKERCKHOVE; N. A. DENTCHEV

    2005-01-01

    The problem of opportunity discovery is central in the entrepreneurial activity. Cognitive limitations determine the search and the analysis of information, and as a consequence constrain the identification for opportunities. Moreover, typical personal characteristics – locus of control, need for independence, and need for achievement – suggest that entrepreneurs would take a central position in their stakeholder environments and as a consequence fail to adapt the complexity of stakeholder re...

  8. Proceedings of a Workshop on Near Fatal Asthma

    Directory of Open Access Journals (Sweden)

    J Mark FitzGerald

    1995-01-01

    Full Text Available Concern has been expressed about rising asthma morbidity and mortality, although the latter appears to have declined recently. A reasonable surrogate for fatal asthma is an episode of near fatal asthma (NFA. The etiology of episodes of NFA appears to be multifactorial. Features that would characterize asthma patients at risk of NFA have been difficult to define but have included psychosocial barriers. environmental exposures, inadequate or inappropriate physician and/or patient responses to deteriorating asthma and, in particular, overreliance on symptomatic bronchodilator therapy. The association between fatal asthma and NFA with beta-agonist use has been controversial, with it being argued that high use of beta-agonists reflects severity of asthma as opposed to being causal. Studies in the laboratory and ambulatory care setting suggest that regular compared with as-required use of beta-agonists is associated with worsening in asthma control. Although a reduced perception of dyspnea has been identified in some asthma patients, it is not universally present in those with NFA. Retrospective data suggest that hyperinflation of the thorax, as judged by total lung capacity, may be a useful marker for subjects at risk of NFA. Future studies should better characterize these risk factors and develop management strategies (both therapeutic and educational that might reduce the risk of subjects experiencing episodes of NFA and, by extension, reducing the continued unacceptable mortality associated with asthma.

  9. Asthma in Children: Risk Factors, Clinical Features and Prevention

    Directory of Open Access Journals (Sweden)

    Serap Balci

    2010-02-01

    Full Text Available Asthma is the most common chronic disease of childhood. It is known that asthma prevalence has increased significantly especially in children in last 20 years. To stop this increase in asthma, causes and prevention measures should be known better. For the management of the illness, control of environmental and trigger factors causing asthma attack are extremely important. Asthmatic children and family should be informed by health staff about changes in their life and measures to prevent the attacks. Through this information asthmatic children and their families can be supported for a better quality of life. [TAF Prev Med Bull 2010; 9(1.000: 79-86

  10. Control of asthma in real life: still a valuable goal?

    Directory of Open Access Journals (Sweden)

    Andriana I. Papaioannou

    2015-06-01

    Full Text Available Although studies show that control of asthma can be achieved in the majority of patients, surveys repeatedly show that this is not the case in real life. Important measures to implement in order to achieve asthma control are trained healthcare professionals, a good patient–doctor relationship, patient education, avoidance of exposure to triggers, personalised management and adherence to treatment. These measures help the majority of asthma patients but have not yet been widely implemented and there should be a concerted action for their implementation. Moreover, further and focused research is needed in severe/refractory asthma.

  11. Asthma in the elderly: a different disease?

    Science.gov (United States)

    Battaglia, Salvatore; Benfante, Alida; Spatafora, Mario

    2016-01-01

    Key points Asthma in the elderly can be difficult to identify due to modifications of its clinical features and functional characteristics. Several comorbidities are associated with asthma in the elderly, and this association differs from that observed in younger patients. In clinical practice, physicians should treat comorbidities that are correlated with asthma (i.e. rhinitis or gastro-oesophageal reflux), assess comorbidities that may influence asthma outcomes (i.e. depression or cognitive impairment) and try to prevent comorbidities related to ­‘drug-associated side-effects (i.e. cataracts, arrhythmias or osteoporosis). “Geriatric asthma” should be the preferred term because it implies the comprehensive and multidimensional approach to the disease in the older populations, whereas “asthma in the elderly” is only descriptive of the occurrence of the disease in this age range. Educational aims To present critical issues in performing differential diagnosis of asthma in the elderly. To offer the instrument to implement the management of asthma in the most advanced ages. Asthma is a chronic airway disease that affects all ages, but does this definition also include the elderly? Traditionally, asthma has been considered a disease of younger age, but epidemiological studies and clinical experience support the concept that asthma is as prevalent in older age as it is in the young. With the ever-increasing elderly population worldwide, the detection and proper management of the disease in old age may have a great impact from the public health perspective. Whether asthma in the elderly maintains the same characteristics as in young populations is an interesting matter. The diagnostic process in older individuals with suspected asthma follows the same steps, namely a detailed history supported by clinical examination and laboratory investigations; however, it should be recognised that elderly patients may partially lose reversibility of airway obstruction

  12. Sibship and Self-esteem in Children with Asthma.

    Science.gov (United States)

    Polizzi, Concetta; Fontana, Valentina; Carollo, Antonio; Bono, Alessandra; Burgio, Sofia; Perricone, Giovanna

    2016-06-15

    This study has explored the valence of sibship that may empower the self-esteem of children with asthma at the interpersonal, environmental control competence, emotionality management, and body-image levels. It has been assumed that the relationship between siblings may have a moderating effect on the negative impact that asthma has on child's development. Seventy children suffering from chronic asthma have been involved: 40 children with siblings (experimental group) and 30 sibling-free children (control group). The children with asthma have exhibited higher levels of self-esteem in comparison with the sibling-free children. The results of the study, at the clinical significance level, highlight how meaningful could be the involvement of healthy siblings to support the development, and to ease the compliance of children suffering from asthma. The outcomes have confirmed the supportive valence of sibship for the self-esteem of the children with asthma. PMID:27433304

  13. Sibship and self-esteem in children with asthma

    Directory of Open Access Journals (Sweden)

    Concetta Polizzi

    2016-06-01

    Full Text Available This study has explored the valence of sibship that may empower the self-esteem of children with asthma at the interpersonal, environmental control competence, emotionality management, and body-image levels. It has been assumed that the relationship between siblings may have a moderating effect on the negative impact that asthma has on child’s development. Seventy children suffering from chronic asthma have been involved: 40 children with siblings (experimental group and 30 sibling-free children (control group. The children with asthma have exhibited higher levels of self-esteem in comparison with the sibling-free children. The results of the study, at the clinical significance level, highlight how meaningful could be the involvement of healthy siblings to support the development, and to ease the compliance of children suffering from asthma. The outcomes have confirmed the supportive valence of sibship for the self-esteem of the children with asthma.

  14. The use of inhaled corticosteroids in pediatric asthma: update.

    Science.gov (United States)

    Hossny, Elham; Rosario, Nelson; Lee, Bee Wah; Singh, Meenu; El-Ghoneimy, Dalia; Soh, Jian Yi; Le Souef, Peter

    2016-01-01

    Despite the availability of several formulations of inhaled corticosteroids (ICS) and delivery devices for treatment of childhood asthma and despite the development of evidence-based guidelines, childhood asthma control remains suboptimal. Improving uptake of asthma management plans, both by families and practitioners, is needed. Adherence to daily ICS therapy is a key determinant of asthma control and this mandates that asthma education follow a repetitive pattern and involve literal explanation and physical demonstration of the optimal use of inhaler devices. The potential adverse effects of ICS need to be weighed against the benefit of these drugs to control persistent asthma especially that its safety profile is markedly better than oral glucocorticoids. This article reviews the key mechanisms of inhaled corticosteroid action; recommendations on dosage and therapeutic regimens; potential optimization of effectiveness by addressing inhaler technique and adherence to therapy; and updated knowledge on the real magnitude of adverse events. PMID:27551328

  15. International Consensus On (ICON) Pediatric Asthma

    Science.gov (United States)

    Papadopoulos, N. G.; Arakawa, H.; Carlsen, K.-H.; Custovic, A.; Gern, J.; Lemanske, R.; Le Souef, P.; Makela, M.; Roberts, G.; Wong, G.; Zar, H.; Akdis, C. A.; Bacharier, L. B.; Baraldi, E.; van Bever, H. P.; de Blic, J.; Boner, A.; Burks, W.; Casale, T. B.; Castro-Rodriguez, J. A.; Chen, Y. Z.; El-Gamal, Y. M.; Everard, M. L.; Frischer, T.; Geller, M.; Gereda, J.; Goh, D. Y.; Guilbert, T. W.; Hedlin, G.; Heymann, P. W.; Hong, S. J.; Hossny, E. M.; Huang, J. L.; Jackson, D. J.; de Jongste, J. C.; Kalayci, O.; Khaled, N.; Kling, S.; Kuna, P.; Lau, S.; Ledford, D. K.; Lee, S. I.; Liu, A. H.; Lockey, R. F.; Lodrup-Carlsen, K.; Lotvall, J.; Morikawa, A.; Nieto, A.; Paramesh, H.; Pawankar, R.; Pohunek, P.; Pongracic, J.; Price, D.; Robertson, C.; Rosario, N.; Rossenwasser, L. J.; Sly, P. D.; Stein, R.; Stick, S.; Szefler, S.; Taussig, L. M.; Valovirta, E.; Vichyanond, P.; Wallace, D.; Weinberg, E.; Wennergren, G.; Wildhaber, J.; Zeiger, R. S.

    2015-01-01

    Asthma is the most common chronic lower respiratory disease in childhood throughout the world. Several guidelines and/or consensus documents are available to support medical decisions on pediatric asthma. Although there is no doubt that the use of common systematic approaches for management can considerably improve outcomes, dissemination and implementation of these are still major challenges. Consequently, the International Collaboration in Asthma, Allergy and Immunology (iCAALL), recently formed by the EAACI, AAAAI, ACAAI and WAO, has decided to propose an International Consensus on (ICON) Pediatric Asthma. The purpose of this document is to highlight the key messages that are common to many of the existing guidelines, while critically reviewing and commenting on any differences, thus providing a concise reference. The principles of pediatric asthma management are generally accepted. Overall, the treatment goal is disease control. In order to achieve this, patients and their parents should be educated to optimally manage the disease, in collaboration with health care professionals. Identification and avoidance of triggers is also of significant importance. Assessment and monitoring should be performed regularly to re-evaluate and fine-tune treatment. Pharmacotherapy is the cornerstone of treatment. The optimal use of medication can, in most cases, help patients control symptoms and reduce the risk for future morbidity. The management of exacerbations is a major consideration, independent from chronic treatment. There is a trend towards considering phenotype specific treatment choices; however this goal has not yet been achieved. PMID:22702533

  16. Know How to Use Your Asthma Inhaler

    Medline Plus

    Full Text Available ... 1 MB] ASL Asthma Film Asthma Clinical Guidelines Air Pollution & Respiratory Health Know How to Use Your Asthma ... 1 MB] ASL Asthma Film Asthma Clinical Guidelines Air Pollution & Respiratory Health File Formats Help: How do I ...

  17. Know How to Use Your Asthma Inhaler

    Medline Plus

    Full Text Available ... MB] ASL Asthma Film Asthma Clinical Guidelines Air Pollution & Respiratory Health Know How to Use Your Asthma ... MB] ASL Asthma Film Asthma Clinical Guidelines Air Pollution & Respiratory Health File Formats Help: How do I ...

  18. Asthma Symptoms in Early Childhood: A public health perspective [Astmasymptomen bij jonge kinderen: een volksgezondheids perspectief

    NARCIS (Netherlands)

    Hafkam-de Groen, E.

    2014-01-01

    This thesis focuses on asthma symptoms in early childhood. From a public health perspective, we aim to improve health and health-related quality of life through the prevention of asthma symptoms and by signaling, counselling or management of children who are at a high risk of developing asthma. The

  19. Applying the Social Ecological Model to Creating Asthma-Friendly Schools in Louisiana

    Science.gov (United States)

    Nuss, Henry J.; Hester, Laura L.; Perry, Mark A.; Stewart-Briley, Collette; Reagon, Valamar M.; Collins, Pamela

    2016-01-01

    Background: In 2010, the Louisiana Asthma Management and Prevention Program (LAMP) implemented the Asthma-Friendly Schools Initiative in high-risk Louisiana populations. The social ecological model (SEM) was used as a framework for an asthma program implemented in 70 state K-12 public schools over 2 years. Methods: Activities included a needs…

  20. Drug prescription pattern for asthma among nigerian doctors in general practice: A cross-sectional survey

    Directory of Open Access Journals (Sweden)

    Ademola E Fawibe

    2012-01-01

    Conclusion: The poor anti-asthma prescribing behavior among these doctors is associated with a low level of participation at update training on asthma management and poor awareness of asthma guidelines. The Nigerian Medical Association and the Nigerian Thoracic Society should urgently address these problems.

  1. A Randomized Controlled Trial of a Public Health Nurse-Delivered Asthma Program to Elementary Schools

    Science.gov (United States)

    Cicutto, Lisa; To, Teresa; Murphy, Suzanne

    2013-01-01

    Background: Childhood asthma is a serious and common chronic disease that requires the attention of nurses and other school personnel. Schools are often the first setting that children take the lead in managing their asthma. Often, children are ill prepared for this role. Our study evaluated a school-based, multifaceted asthma program that…

  2. Examining the association between childhood asthma and parent and grandparent asthma status: Implications for Practice

    OpenAIRE

    Valerio, Melissa A.; Andreski, Patricia M.; Schoeni, Robert F.; McGonagle, Katherine A.

    2010-01-01

    Examination of intergenerational asthma beyond maternal asthma has been limited. The association between childhood asthma and intergenerational asthma status among a national cohort of children was examined.

  3. Asthma Symptoms in Early Childhood: A public health perspective

    NARCIS (Netherlands)

    E.H.D. Hafkamp-De Groen (Esther)

    2014-01-01

    markdownabstract__Abstract__ This thesis focuses on asthma symptoms in early childhood. From a public health perspective, we aim to improve health and health-related quality of life through the prevention of asthma symptoms and by signaling, counselling or management of children who are at a high r

  4. Asthma and Therapeutics: Recombinant Therapies in Asthma

    OpenAIRE

    Cockcroft Donald W

    2005-01-01

    Abstract Numerous recombinant therapies are being investigated for the treatment of asthma. This report reviews the current status of several of these novel agents. Anti-immunoglobulin (Ig)E (omalizumab, Xolair) markedly inhibits all aspects of the allergen challenge in subjects who have reduction of free serum IgE to undetectable levels. Several clinical studies in atopic asthma have demonstrated benefit by improved symptoms and lung function and a reduction in corticosteroid requirements. E...

  5. The Head-off Environmental Asthma in Louisiana (HEAL) Study—Methods and Study Population

    OpenAIRE

    Chulada, Patricia C.; Kennedy, Suzanne; Mvula, Mosanda M.; Jaffee, Katy; Wildfire, Jeremy; Thornton, Eleanor; Cohn, Richard D.; Grimsley, L. Faye; Mitchell, Herman; El-Dahr, Jane; Sterling, Yvonne; Martin, William J.; White, LuAnn; Stephens, Kevin U.; Lichtveld, Maureen

    2012-01-01

    Background: In the city of New Orleans, Louisiana, and surrounding parishes (NOLA), children with asthma were perilously impacted by Hurricane Katrina as a result of disrupted health care, high home mold and allergen levels, and high stress. Objectives: The Head-off Environmental Asthma in Louisiana (HEAL) study was conducted to examine relationships between the post-Katrina environment and childhood asthma in NOLA and assess a novel asthma counselor intervention that provided case management...

  6. Evaluation of a pilot national online asthma e-learning program for secondary school students.

    LENUS (Irish Health Repository)

    Hughes, Mary

    2014-06-01

    Ireland has the fourth highest incidence of asthma in the world, with Irish children losing on average 10 days of school per annum due to their asthma. It is highly probable that a large percentage of students in each class in Irish schools have asthma and are required to manage symptoms during the out-of-home period. Young people with chronic illnesses such as asthma find themselves labelled and marginalized due to a lack of awareness of others about their condition.

  7. Factors related to under-diagnosis and under-treatment of childhood asthma in metropolitan France.

    OpenAIRE

    Annesi-Maesano Isabella; Sterlin Carla; Caillaud Denis; de Blay Fréderic; Lavaud François; Charpin Denis; Raherisson Chantal

    2012-01-01

    Abstract Background Under-diagnosis and under-treatment of childhood asthma were investigated in France using data collected during the 6 Cities Study, the French contribution to the International Study of Asthma and Allergies in Childhood. Methods 7,781 schoolchildren aged between 9 and 10 years underwent a medical visit including skin prick tests to common allergens and exercise test for Exercise-Induced Asthma (EIA) and their parents filled in a standardized questionnaire on asthma, manage...

  8. Monitoring asthma in childhood

    Directory of Open Access Journals (Sweden)

    Karin C. Lødrup Carlsen

    2015-06-01

    Full Text Available The goal of asthma treatment is to obtain clinical control and reduce future risks to the patient. However, to date there is limited evidence on how to monitor patients with asthma. Childhood asthma introduces specific challenges in terms of deciding what, when, how often, by whom and in whom different assessments of asthma should be performed. The age of the child, the fluctuating course of asthma severity, variability in clinical presentation, exacerbations, comorbidities, socioeconomic and psychosocial factors, and environmental exposures may all influence disease activity and, hence, monitoring strategies. These factors will be addressed in herein. We identified large knowledge gaps in the effects of different monitoring strategies in children with asthma. Studies into monitoring strategies are urgently needed, preferably in collaborative paediatric studies across countries and healthcare systems.

  9. The cost of asthma: can it be reduced?

    Science.gov (United States)

    Mellis, C M; Peat, J K; Woolcock, A J

    1993-03-01

    Asthma is a major public health problem in developed countries, where it consumes a large and increasing share of scarce health resources. Ideally, medical management should be both optimal in terms of improving the patient's quality of life, and cost-effective for society. At present, there is very little information relating to costs and economic efficiency of current asthma management. Although the true total cost of asthma is unknown, current estimates suggest it is high. The main value of recent total cost estimates is that they identify the most expensive areas of asthma costs, and ideally, formal cost-effectiveness analyses should be concentrated on these areas. Asthma is still under- or inappropriately diagnosed, and undertreated. Several national and international consensus plans for the optimal management of asthma in children and adults have been published. If these inadequacies in asthma management were corrected, using current treatment recommendations, the overall cost of asthma from both the community and patient perspective should fall. The situation requires increased use of preventative medications {sodium cromoglycate (cromolyn sodium) or inhaled corticosteroids}, more widespread use of written crisis plans, more proactive medical consultations (rather than reactive or urgent consultations), further expansion of asthma education programmes, and further education of medical practitioners about the optimum management of both long term asthma and the acute exacerbation of asthma in the patient's home, the doctor's office, the hospital emergency room and the hospital inpatient setting. The increased costs associated with these measures would be more than offset by reduced expenditure on bronchodilator drugs, less widespread use of nebulisers at home and in hospitals, reduced antibiotic usage, reduced need for expensive emergency medical care and particularly reduced utilisation of hospital resources. To ensure that resources are being directed into

  10. Basic mechanisms of asthma.

    OpenAIRE

    Boushey, H A; Fahy, J.V.

    1995-01-01

    Results of studies of the epidemiology, physiology, histopathology, and cell biology of asthma have revised our conception of the disease. Epidemiologic studies have shown asthma to be an important cause of death, suffering, and economic hardship. Physiologic studies have shown that asthma is a chronic illness characterized by persistent bronchial hyperreactivity. Histopathologic studies have shown characteristic changes: epithelial damage, deposition of collagen beneath the basement membrane...

  11. Ketotifen and nocturnal asthma.

    OpenAIRE

    Catterall, J R; Calverley, P M; Power, J T; Shapiro, C M; Douglas, N J; Flenley, D. C.

    1983-01-01

    Patients with asthma often wheeze at night and they also become hypoxic during sleep. To determine whether ketotifen, a drug with sedative properties, is safe for use at night in patients with asthma, we performed a double blind crossover study comparing the effects of a single 1 mg dose of ketotifen and of placebo on arterial oxygen saturation (SaO2), breathing patterns, electroencephalographic (EEG) sleep stage, and overnight change in FEV1 in 10 patients with stable asthma. After taking ke...

  12. Epidemiological Trends in Asthma

    OpenAIRE

    Sears, Malcolm R

    1996-01-01

    Many markers of asthma morbidity have shown substantial increases over the past two decades, including family physician visits, use of anti-asthma medications, emergency room visits and hospital admissions. The reported prevalence of diagnosed asthma and of wheezing has increased, especially in children, with accompanying evidence of increased atopy and increased airway responsiveness. Allergen exposure and parental smoking are significant risk factors for childhood wheezing, whereas the infl...

  13. The value of exhaled nitric oxide to identify asthma in smoking patients with asthma-like symptoms

    DEFF Research Database (Denmark)

    Malinovschi, Andrei; Backer, Vibeke; Harving, Henrik;

    2012-01-01

    The fraction of nitric oxide in exhaled air (FeNO) is used in asthma diagnosis and management. Smoking reduces FeNO and 20-35% of asthmatics are smoking. However no guidelines exist on the diagnostic value of FeNO in smokers. Therefore we assessed the value of FeNO to diagnose asthma...

  14. The role of CRAC channel in asthma.

    Science.gov (United States)

    Kaur, Manminder; Birrell, Mark A; Dekkak, Bilel; Reynolds, Sophie; Wong, Sissie; De Alba, Jorge; Raemdonck, Kristof; Hall, Simon; Simpson, Karen; Begg, Malcolm; Belvisi, Maria G; Singh, Dave

    2015-12-01

    Asthma is increasing globally and current treatments only manage a proportion of patients. There is an urgent need to develop new therapies. Lymphocytes are thought to play a central role in the pathophysiology of asthma through the production of inflammatory mediators. This is thought to be via the transcription factor NFAT which in turn can be activated through Ca(2+) release-activated Ca(2+) (CRAC) channels. The aim of this work was to investigate the role of CRAC in clinical and pre-clinical models of allergic asthma. Initial data demonstrated that the NFAT pathway is increased in stimulated lymphocytes from asthmatics. To confirm a role for the channel we showed that a selective inhibitor, Synta 66, blocked mediator production from lymphocytes. Synta 66 inhibited CD2/3/28 induced IL-2, IL-7, IL-13 & IFNΥ in a concentration-dependent manner in healthy and severe asthma donors, with over 60% inhibition observed for all cytokines. NFAT pathway was also increased in a pre-clinical asthma model. In this model we have demonstrated that CRAC played a central role in the airway inflammation and late asthmatic response (LAR). In conclusion, our data provides evidence that suggests targeting CRAC channels could be of therapeutic benefit for asthma sufferers.

  15. Early interventions in asthma with inhaled corticosteroids.

    Science.gov (United States)

    Laitinen, L A; Altraja, A; Karjalainen, E M; Laitinen, A

    2000-02-01

    We have earlier shown epithelial damage in the airway mucosa in patients with asthma. Later other structural changes have been recognized in asthma, such as deposition of collagen and tenascin in the subepithelial basement membrane and changes in the laminin subchain composition. These processes are modified by an inflammatory process in the airways. Both the United States National Institutes of Health and the British Thoracic Society guidelines on the management of asthma emphasize the need for early use of anti-inflammatory drugs. Many clinical studies that used airway biopsy specimens have shown a decrease in airway inflammatory cell numbers after inhaled corticosteroid therapy. However, there is very little information on the effects of asthma medication on the structural components of the airways. Both the synthesis and degradation of many extracellular matrix components may be affected by the disease process and the drugs resulting in altered remodeling and gene expression in the airways. Because there are only a few studies that try to identify early changes in asthma, it is not known whether the anti-inflammatory treatment of asthma proposed by the guidelines is started early enough.

  16. Asthma: Basic Information

    Science.gov (United States)

    ... physicians' office Health care providers - Medical clinics/physicians' office Health care providers - Other Parents - Home Case Studies Open Airways for Schools Asthma Care Training Wee Wheezers ...

  17. Asthma in Olympians.

    Science.gov (United States)

    Carlsen, Kai-Håkon

    2016-01-01

    High prevalence of asthma has been reported repeatedly among elite athletes, especially among endurance athletes. So many athletes used asthma drugs that the objective demonstration of bronchial hyperresponsiveness was required to obtain approval for their use in international sports until 2012 when the most used inhaled asthma drugs was allowed for free use, but with a maximum dose for inhaled β2-agonists. Several factors contribute to the development of asthma among the Olympians causing airways inflammation and bronchial hyper-responsiveness. PMID:26631837

  18. Asthma among mink workers

    DEFF Research Database (Denmark)

    Grøntved, Berit; Carstensen, Ole; Petersen, Rolf;

    2014-01-01

    We report two cases of asthma among mink workers. The first case is about a mink farmer who had asthma that was difficult to treat. In the medical history there was no clear relation to work, and no conclusive work relation with peak flow monitoring. He had a positive histamine release test to mink...... urine. The second case is about a mink farm worker, who had an asthma attack when handling mink furs. Peak flow monitoring showed a clear relation to this work, but there were no signs of allergy. We conclude that these two cases suggest an increased risk of asthma among mink workers....

  19. Improving asthma severity and control screening in a primary care pediatric practice.

    Science.gov (United States)

    Sudhanthar, Sathyanarayan; Thakur, Kripa; Sigal, Yakov; Turner, Jane; Gold, Jonathan

    2016-01-01

    Asthma is the most commonly encountered chronic disease in children. Periodic assessment of asthma severity and control is an integral part of asthma management, but patients with uncontrolled asthma don't always schedule routine asthma care visits. The aim of this project was to improve asthma control and severity screening in a primary care setting by using a validated tool for all visits for patients with a diagnosis of asthma aged 4-21 years. Our QI team developed a protocol to administer the Asthma Control Test (TM), a validated questionnaire to assess asthma control. The stakeholders involved were the physicians, nursing staff, and the Health Information Team (HIT). All patients who had a prior diagnosis of asthma or with an asthma medication in their chart, who presented for any clinical visit including asthma were administered ACT. The staff scored the ACT and included the form in the encounter sheet so that the physicians can review the scores, address the asthma control, severity, and document in the chart. The number of patients whose asthma control was assessed improved from 10% per year to 85% after the three PDSA cycles. Administration of the tool did not impact the flow of the patients in a busy primary care practice. Screening asthma severity and control for patients diagnosed with asthma with a validated questionnaire when presenting for any chief complaint including asthma will help the provider address the severity and control of asthma symptoms in a timely manner and would potentially help prevent unwanted emergency department or urgent care usage. PMID:27408718

  20. Improving asthma severity and control screening in a primary care pediatric practice

    Science.gov (United States)

    Sudhanthar, Sathyanarayan; Thakur, Kripa; Sigal, Yakov; Turner, Jane; Gold, Jonathan

    2016-01-01

    Asthma is the most commonly encountered chronic disease in children. Periodic assessment of asthma severity and control is an integral part of asthma management, but patients with uncontrolled asthma don't always schedule routine asthma care visits. The aim of this project was to improve asthma control and severity screening in a primary care setting by using a validated tool for all visits for patients with a diagnosis of asthma aged 4-21 years. Our QI team developed a protocol to administer the Asthma Control Test (TM), a validated questionnaire to assess asthma control. The stakeholders involved were the physicians, nursing staff, and the Health Information Team (HIT). All patients who had a prior diagnosis of asthma or with an asthma medication in their chart, who presented for any clinical visit including asthma were administered ACT. The staff scored the ACT and included the form in the encounter sheet so that the physicians can review the scores, address the asthma control, severity, and document in the chart. The number of patients whose asthma control was assessed improved from 10% per year to 85% after the three PDSA cycles. Administration of the tool did not impact the flow of the patients in a busy primary care practice. Screening asthma severity and control for patients diagnosed with asthma with a validated questionnaire when presenting for any chief complaint including asthma will help the provider address the severity and control of asthma symptoms in a timely manner and would potentially help prevent unwanted emergency department or urgent care usage. PMID:27408718